# Development and Feasibility Testing of an Integrated PTSD and Adherence Intervention Cognitive Processing Therapy-Lifesteps (CPT-L) to Improve HIV Outcomes

> **NIH NIH R34** · MEDICAL UNIVERSITY OF SOUTH CAROLINA · 2021 · $225,750

## Abstract

PROJECT SUMMARY/ABSTRACT
Despite consistently high rates of Post-Traumatic Stress Disorder (PTSD) in persons living with HIV (PLWH)
and the alarmingly poor HIV-related health outcomes associated with PTSD, an effective evidence-based
treatment for reduction of PTSD symptoms in PLWH does not exist. Negative reinforcement conceptual
models posit that avoidant behavior (a hallmark symptom of PTSD) demonstrated by PLWH with co-occurring
PTSD can contribute to poor antiretroviral therapy (ART) adherence. However, research evaluating the impact
of evidence-based treatment for PTSD among HIV infected populations on HIV outcomes is scarce. The
Cognitive Processing Therapy (CPT) protocol is an evidence-based PTSD treatment that may also address
HIV-related intersectional stigma with targeted modifications and improve ART adherence and subsequent
viral suppression through reduction of avoidant coping. The proposed 3 year study will leverage infrastructure
through the Ryan White network and be the first pilot RCT to test feasibility of an integrated evidence based
PTSD treatment (CPT) with an adherence intervention (Lifesteps) delivered in a Ryan White clinic to improve
PTSD symptoms, adherence to ART, and retention in HIV care. The specific aims are: 1) To deliver un-
adapted CPT and Lifesteps with 12 PLWH with co-occurring PTSD and collect qualitative feedback to
maximize acceptability and relevance of the integrated CPT-L protocol; 2) To determine feasibility of the
modified CPT protocol using a randomized controlled 2 (treatment type) x 3 (time points) trial design in 60
PLWH with comorbid PTSD exploring impact of CPT-L on PTSD symptoms, avoidant coping (posited
mechanism of action), substance use, depression, ART adherence, CD4 count, viral load, and engagement in
care compared to a Lifesteps +Standard of Care condition. In Aim 1, qualitative data from theater testing and
exit interviews collected after 12 cases of beta testing and feedback from the Community Advisory Board and
topical experts will inform refinement of the research protocol. In Aim 2, CPT-L will then be piloted with 60
PLWH meeting PTSD diagnostic criteria. Participants will be randomized to the control condition (Lifesteps+
SOC; N=30) or the intervention condition (CPT-L; N=30) and will complete assessments at baseline, post-
intervention (6 weeks), and 3 months post-randomization. Specific feasibility benchmarks (e.g., retention,
fidelity, satisfaction) will be examined and variability of estimates will be obtained. This data are critical to
informing an R01 application for rigorous evaluation of CPT-L as a vehicle for improving ART adherence and
retention in care. If successful, this research extends PTSD treatment approaches as a paradigm to reduce
barriers to ART adherence, which is an innovative use of established behavioral interventions and significant
because results support the U=U campaign and can help prevent the transmission of HIV infection through
increased viral suppres...

## Key facts

- **NIH application ID:** 10258696
- **Project number:** 1R34MH125706-01A1
- **Recipient organization:** MEDICAL UNIVERSITY OF SOUTH CAROLINA
- **Principal Investigator:** Cristina M Lopez
- **Activity code:** R34 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $225,750
- **Award type:** 1
- **Project period:** 2021-04-01 → 2024-02-29

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10258696

## Citation

> US National Institutes of Health, RePORTER application 10258696, Development and Feasibility Testing of an Integrated PTSD and Adherence Intervention Cognitive Processing Therapy-Lifesteps (CPT-L) to Improve HIV Outcomes (1R34MH125706-01A1). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10258696. Licensed CC0.

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