Comparing the brief Holistic Health for HIV (3H+) to the Holistic Health Recovery Program (HHRP plus ) among people with HIV and opioid use disorder: Results from a randomized, controlled non-inferiority trial
Document Type
Article
Publication Date
11-1-2024
Abstract
Few evidence-based interventions have been widely adopted in common clinical settings, particularly for opioid-dependent people with HIV (PWH) seeking drug treatment. We developed a brief evidence-based intervention, Holistic Health for HIV (3H+), specifically for ease of implementation and integration within drug treatment settings. In this study, we compared 3H+ to the gold standard, Holistic Health Recovery Program (HHRP+) using a non-inferiority trial. Between 2012 and 2017, 106 participants were randomly assigned to either the brief 3H+ intervention or the gold standard HHRP+. HIV treatment (ART adherence, viral suppression) and risk behaviors (sharing injection equipment, condom use) were compared between the two arms at baseline, end-of-intervention (EOI-12 weeks) and at follow-up (24 weeks). Average treatment effect was calculated based on the difference-in-difference (DID) estimator and a non-parametric bootstrap was used to assess non-inferiority. At the 12-week EOI point, 3H+ was found to be non-inferior to HHRP+ with respect to multiple outcomes: percent sharing syringes and needles (DID:1.4, 95%CI -18.6,21.5], p<0.01) and attainment of high ART adherence (DID: 9.7, 95%CI: -13.1, 32.2], p = 0.04). At the 24-week EOI point, 3H+ was found to be non-inferior to HHRP+ with respect to percent sharing syringes and needles (DID: 8.9, -10.1, 28.30], p = 0.04) and attainment of viral suppression (DID: 18.9, 95% CI:-7.1, 42.0], p = 0.01). For other indicators, such as consistent condom use, the hypothesis test for non-inferiority was inconclusive at the 12-week EOI (DID: -20.2, 95%CI -48.9-10.7], p = 0.51). For HIV treatment as prevention to be effective, PWH need to achieve viral suppression. In the absence of this success, they must reduce HIV risk behaviors. The finding that 3H+ was non-inferior to HHRP+ suggests that brief behavioral interventions can be deployed in real world settings to help more efficiently achieve Ending the HIV Epidemic goals.
Divisions
fac_med,ceria
Funders
United States Department of Health & Human Services National Institutes of Health (NIH) - USA NIH National Institute on Drug Abuse (NIDA) (R01 DA032290) ; (K01 DA051346) ; (K24 DA017072) ; (K24 DA051344),United States Department of Health & Human Services National Institutes of Health (NIH) - USA NIH National Institute of Mental Health (NIMH) (T32MH07438714)
Publication Title
PLoS ONE
Volume
19
Issue
11
Publisher
Public Library of Science
Publisher Location
1160 BATTERY STREET, STE 100, SAN FRANCISCO, CA 94111 USA