# Testing a Multi-Component Intervention to Improve Health Outcomes and Quality of Life among Rural Older Adults Living with HIV

> **NIH NIH R56** · MEDICAL COLLEGE OF WISCONSIN · 2020 · $508,867

## Abstract

More than 55,000 people living with HIV (PLH) in the US live in rural areas, and more than 2,300 rural
residents are diagnosed with HIV each year. PLH who live in rural areas have higher mortality rates compared
with non-rural PLH. Rural PLH are diagnosed with HIV at a more advanced stage than non-rural individuals
and present for medical care later, making them more likely to face comorbidities and need complex medical
care. Rural PLH are also less likely than their urban counterparts to remain engaged in HIV care and to be
virally suppressed. Compared with younger PLH, older PLH may face additional challenges to maintaining their
health and wellbeing, and older PLH who also live in rural areas face the doubly challenging prospect of
maintaining adherence to HIV care and managing medical conditions while living in a rural environment. Few
interventions aimed at increasing VL suppression and improving health-related quality of life (HRQOL) exist for
rural older PLH. Our previous qualitative and survey research with rural older PLH nationwide (N = 476)
identified low social support, HIV-related stigma, lack of technology access, and structural barriers (such as
difficulties with housing, food, transportation, and insurance) as key predictors of engagement in HIV care, viral
load (VL) suppression, and HRQOL for this population. Based on this work, we propose developing an
optimized intervention for rural older PLH using the multiphase optimization strategy (MOST). We will evaluate
four intervention components, adapted from evidence-based interventions and delivered remotely:
(1) counselor-facilitated peer social support, (2) HIV stigma reduction, (3) strengths-based case management,
and (4) individually-tailored technology use optimization. We will recruit 400 rural older PLH nationwide through
partnerships with community agencies and online advertisements, with an emphasis on persons living in the
states prioritized in the US HHS’ “Ending the HIV Epidemic” (EtHE) plan. Following baseline surveys
(completed online, by mail, or by phone) and HIV VL testing (via self-collected dried blood spot samples),
participants will be randomized to receive or not receive each of the four intervention components in a
fractional factorial design. Follow-up surveys will occur at 3, 6, and 12 months, and VL testing at 6 and 12
months. Surveys will assess HRQOL, engagement in care, mental health, covariates, and hypothesized
mediators (e.g., social support, HIV stigma, self-efficacy, eHealth literacy). Primary outcomes are VL
suppression and HRQOL, and secondary outcomes are engagement in care and depressive symptoms. In line
with the MOST framework, each component’s impact on VL and HRQOL will be evaluated, and an optimized
intervention identified. We will also assess information related to the acceptability, feasibility, and cost of
intervention components. We hypothesize that components will increase (1) the proportion of participants that
have VL suppression and...

## Key facts

- **NIH application ID:** 10246599
- **Project number:** 1R56NR019443-01
- **Recipient organization:** MEDICAL COLLEGE OF WISCONSIN
- **Principal Investigator:** ANDREW E PETROLL
- **Activity code:** R56 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $508,867
- **Award type:** 1
- **Project period:** 2020-09-08 → 2022-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10246599

## Citation

> US National Institutes of Health, RePORTER application 10246599, Testing a Multi-Component Intervention to Improve Health Outcomes and Quality of Life among Rural Older Adults Living with HIV (1R56NR019443-01). Retrieved via AI Analytics 2026-05-21 from https://api.ai-analytics.org/grant/nih/10246599. Licensed CC0.

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