Rise: Improving HIV Treatment Adherence Through Peer Counseling
A Community-Based Intervention to Support Antiretroviral Therapy Adherence Among Black / African American People Living with HIV
Photo by SDI Productions / Getty Images
RAND and APLA Health have partnered since 2006 on a series of community-based participatory research studies to develop and test Rise, a one-on-one peer counseling program to improve antiretroviral therapy (ART) adherence among Black / African American clients.
Rise, which is based on APLA Health’s Treatment Advocacy program, was adapted for Black / African American clients through a community engagement process. Rise counselors provide education about adherence and ART, work with clients to problem solve around adherence barriers, and link clients to services to address unmet needs (e.g., for food, housing, behavioral health).
Rise is delivered over six months and consists of three core sessions held in month one, followed by two booster sessions at months four and six. These are supplemented with up to two additional booster sessions for clients who continue to struggle with adherence.
Rise was tested in a randomized controlled trial at APLA Health from January 2018–December 2021. This study included 166 Black adults living with HIV in Los Angeles County, California. The average age of participants was 49, and 76% were male. Eighty-five participants received the intervention and and 81 control participants did not.
Participants were primarily recruited through APLA Health programs, staff, and clients, as well as outreach to other agencies, at local events, and on the street. Participants completed surveys at baseline, and one month and six months after the intervention. Adherence was monitored with electronic medication bottle caps that recorded their bottle openings for their ART medication (i.e., electronic adherence monitoring), and viral load was assessed with blood draws and medical records.
Rise led to increased ART adherence, lower HIV stigma, and reduced medical mistrust (such as less belief that ART is poison). The estimated cost per person to reach optimal adherence was $335 per person for in-person sessions that used electronic adherence monitoring, and $96 per person for telephone sessions (without electronic adherence monitoring), as was done during the COVID-19 pandemic.
For more information about the study, please contact Laura Bogart, RAND Corporation, phone (310) 393-0411 x 7281.
- Laura M. Bogart Email Senior Behavioral Scientist, RAND Corporation
- Glenn Wagner Email Senior Behavioral Scientist, RAND Corporation
- Madhumita (Bonnie) Ghosh Dastidar Email Senior Statistician; Head, RAND Statistics Group, RAND Corporation
- David J. Klein Email Statistical Analyst, RAND Corporation
- Sebastian Linnemayr Email Senior Economist, RAND Corporation
- Uzaib Saya Email Adjunct Policy Researcher, RAND Corporation
- Mahlet Gizaw Email Adjunct Policy Researcher, RAND Corporation
- Matt G. Mutchler Director, Community-Based Research, APLA Health
- Jeff Bailey Director of HIV Access and Community-Based Services, APLA Health
- Sean Lawrence Senior Study Coordinator, APLA Health
- Keshav Tyagi Senior Study Coordinator, APLA Health
- Damone Thomas Rise Intervention Counselor, Healing with Hope, Corp.
- Kathy Goggin Glasscock Chair, Children’s Mercy Kansas City and Professor of Medicine and Pharmacy, University of Missouri – Kansas City
Funding for this study was provided by the National Institutes of Health (R21NR010284, R01MD006058, R01NR017334). The team is grateful for the contributions of the APLA Health Community-Based Research Community Advisory Board.