# Standing Tall - A Pilot Randomized Controlled Trial of a Community-Based Intervention to Improve Health Outcomes for Newly Diagnosed HIV-Positive Young Adults in South Africa

> **NIH NIH R34** · BRIGHAM AND WOMEN'S HOSPITAL · 2021 · $66,136

## Abstract

PROJECT SUMMARY
Adolescents and young adults (AYA) living with HIV in South Africa are at high-risk for HIV treatment failure
and death. Only 10% are virally suppressed, despite widespread treatment availability. There is a dearth of
evidence regarding the effectiveness of interventions focused on improving antiretroviral therapy (ART)
initiation and retention in this key population. Formative research by Katz (PI) et al., has shown that South
Africans newly diagnosed with HIV may not initiate ART due to social costs associated with being “sick.” For
these individuals, social integration and connectivity may promote effective coping strategies. Bekker (Site-PI)
et al., developed a model of care (“The Hlanganani Program”) that utilizes social integration to engage AYA,
newly diagnosed with HIV in clinic facilities, in a dynamic, three-session cognitive behavioral support group
facilitated by lay health counselors (LHCs). The intervention shows promising early results (100% linkage to an
initial HIV clinic visit among a sub-sample tested vs. 58% in historical controls, p<.001). Despite this early
success, potential implementation was limited by a lack of a concurrent control arm. In the proposed R34, we
will adapt this socio-behavioral intervention through an iterative approach, to address individual, social, and
structural barriers to treatment initiation and viral suppression for South Africans, ages 18-24, newly diagnosed
with HIV. The proposed intervention, titled Standing Tall, is guided by Social Action Theory and has three
interrelated components: (1) a three-session group intervention adapted from Hlanganani, delivered weekly by
LHCs, focused on treatment uptake, adherence, and health maintenance (addressing individual factors); (2) six
months of ongoing treatment and social support (addressing social factors); and (3) provision of immediate
ART and refills in the context of an ART Initiation Club (addressing structural factors). We have informed the
design of our intervention by performing semi-structured qualitative interviews with 20 AYA newly diagnosed
with HIV, with attention to gender-specific needs in this population, and 10 healthcare providers (Aim 1). We
then tested components of the intervention with 10 AYA newly diagnosed with HIV using an iterative phased
approach(Aim 2). Finally, we will leverage established community-based testing platforms created at the
Desmond Tutu HIV Foundation which provide rapid HIV-testing, to conduct a pilot randomized controlled trial
of our intervention (Aim 3). One-hundred ART-naïve, AYA newly diagnosed with HIV will be randomly
assigned to one of two study arms: 1) Standing Tall or; 2) treatment as usual (immediate referral for ART at
local clinics).Behavioral and biological data will be collected to assess the impact of Standing Tall on ART
initiation within three months of testing, viral load suppression and engagement in care at six months of ART
initiation, and psychosocial mediators of ART i...

## Key facts

- **NIH application ID:** 10378280
- **Project number:** 3R34MH114897-03S1
- **Recipient organization:** BRIGHAM AND WOMEN'S HOSPITAL
- **Principal Investigator:** Ingrid T. Katz
- **Activity code:** R34 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $66,136
- **Award type:** 3
- **Project period:** 2021-07-02 → 2023-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10378280

## Citation

> US National Institutes of Health, RePORTER application 10378280, Standing Tall - A Pilot Randomized Controlled Trial of a Community-Based Intervention to Improve Health Outcomes for Newly Diagnosed HIV-Positive Young Adults in South Africa (3R34MH114897-03S1). Retrieved via AI Analytics 2026-05-28 from https://api.ai-analytics.org/grant/nih/10378280. Licensed CC0.

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