# Optimizing the HIV Treatment Continuum with a Stepped Care Model for Youth Living with HIV

> **NIH NIH U19** · UNIVERSITY OF CALIFORNIA LOS ANGELES · 2020 · $190,539

## Abstract

Project Summary/Abstract
 Among the 62,400 Youth Living with HIV (YLH) aged 12-24 years old, 36% are linked to health care and
only 6% of YLH are virally suppressed.1 It is imperative that YLH achieve viral suppression in order to reduce
the probability of infecting others, as well as increasing the length and quality of their own life. Stepped Care is
a strategy used in managing other chronic diseases, not yet applied to HIV. Providers implement the least
intensive intervention needed to achieve the treatment goal and intensify the intervention until the treatment
goal is achieved. Study 2 tests a Stepped Care Model to achieve viral suppression – by increasing adherence
to the HIV Treatment Continuum.
 This U19's strategy for retaining the cohort, monitoring outcomes, and linking YLH to care is the Standard
Care Condition in Study 2 (labeled Prototype Retention/Prevention Strategy in other cores or studies) and will
be combined by an Automated Messaging and Monitoring Intervention (AMMI) for YLH. The Stepped Care arm
will have three levels of intervention: Level 1: Standard Care; Level 2: a Peer Support and AMMI (PS-AMMI)
plus the Standard Care; and Level 3: a Coach plus PS-AMMI plus the Standard Care. The PS-AMMI and
Coaching will be both in-person contacts, as well as on social media, texting, and probes to monitor behaviors
over time. Having a detectable viral load at a 4 month assessment, triggers increasing intensity in the level of
intervention provided.
 YLH with established HIV infection (N=220) will be identified by screening each youth seeking services at
five homeless shelters and gay-identified community based organizations in Los Angeles and New Orleans.
The sample is expected to be 79% male Gay, Bisexual, and Transgender YLH (GBTY), 5% heterosexual
males, 71% African-American, 15% Latino, and 16% female. The YLH will be randomly assigned during the
recruitment process when it is determined that the YLH has an established HIV infection by the interviewer in
the Recruitment, Engagement, and Retention Center (RERC).Over 24 months, viral load will be monitored as
the primary outcomes with dried blood spots. Secondary outcomes will be sexually transmitted infection (STI),
serious substance abuse, and retention in care and antiretroviral (ARV) therapy adherence. The study will
examine the mediating effect of reducing substance use and reducing depression on viral suppression, as well
document the frequency and type of life challenges and barriers YLH experience to achieve viral suppression
and how the quality of the peer support and coaching may impact outcomes. The results of this study will
potentially influence CDC's policies on how to diffuse evidence-based practices and provide CDC with good
estimates on the costs of repeat testing among GBTY.

## Key facts

- **NIH application ID:** 9964867
- **Project number:** 5U19HD089886-05
- **Recipient organization:** UNIVERSITY OF CALIFORNIA LOS ANGELES
- **Principal Investigator:** ELIZABETH Mayfield ARNOLD
- **Activity code:** U19 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $190,539
- **Award type:** 5
- **Project period:** — → 2022-11-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9964867

## Citation

> US National Institutes of Health, RePORTER application 9964867, Optimizing the HIV Treatment Continuum with a Stepped Care Model for Youth Living with HIV (5U19HD089886-05). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/9964867. Licensed CC0.

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