# Improving retention in care for persons with HIV who use substances by increasing acceptance and reducing stigma

> **NIH NIH R34** · BROWN UNIVERSITY · 2022 · $242,126

## Abstract

PROJECT SUMMARY/ABSTRACT
 As many as 50% of people with HIV (PWH) are not in regular HIV primary care in the U.S. This is
particularly common for PWH who use substances such as cocaine, methamphetamines, and opioids. PWH
who are not consistently retained in care are at risk for: delayed antiretroviral treatment (ART) initiation,
reduced ART adherence, unsuppressed viremia, and mortality. Moreover, poor retention means effective ART
cannot be leveraged to prevent further HIV transmission. The long-term goal is to develop impactful, brief
intervention techniques that can be easily integrated into usual care practices to enhance HIV care retention.
The objective of this proposal, which is the next step in attaining the long-term goal, is to adapt and refine an
existing retention intervention in the context of an open trial and a small randomized controlled trial. We will
adapt a brief, 2-session acceptance-based behavioral therapy (ABBT) intervention to enhance retention in HIV
care for people who use substances by targeting stigma. ABBT promotes an accepting stance towards life’s
challenges and encourages participants to thoughtfully disclose the serostatus and/or substance abuse
problems as a behavioral step towards challenging stigmatization fears. The central hypothesis is that
increased tolerance of stigmatization, facilitated through increased acceptance of HIV status and substance
abuse behaviors, will increase PWH’s longitudinal commitment to care.
 The aims of this proposal are: (1) To use an iterative process to refine ABBT for substance using, out-of-
care PWH by conducting an open trial in English-speakers (n=7) and monolingual Spanish speakers (n=3);
and, (2) To conduct a pilot randomized controlled trial (n = 50; incl. 10 Spanish speakers) of ABBT vs.
Treatment-as-Usual (TAU). Primary outcome will be retention in care. The sample will consist of 60 HIV
patients who have not attended a medical visit in at least 9 months at our infectious diseases clinic in
Providence, R.I. The approach is innovative in that it departs from the status quo by using brief acceptance-
based psychotherapy techniques, delivered by telehealth, to increase acceptance of HIV status and substance
abuse problems and promoting careful and thoughtful disclosure as a specific mechanism to support retention.
Additionally, ABBT will be adapted for monolingual Spanish speakers as this cohort of PWH needs more
research attention. Upon successful completion of the proposed R34 research, this study will contribute
significant actionable data that will lay the groundwork for a large-scale investigation of ABBT for out-of-care
PWH who use substances.

## Key facts

- **NIH application ID:** 10409767
- **Project number:** 5R34DA053738-02
- **Recipient organization:** BROWN UNIVERSITY
- **Principal Investigator:** Ethan Moitra
- **Activity code:** R34 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $242,126
- **Award type:** 5
- **Project period:** 2021-06-01 → 2024-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10409767

## Citation

> US National Institutes of Health, RePORTER application 10409767, Improving retention in care for persons with HIV who use substances by increasing acceptance and reducing stigma (5R34DA053738-02). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10409767. Licensed CC0.

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