4 - (SYM 101) Iterative Adaptation of a Psycho-behavioral Intervention to Mitigate the Negative Consequences of Stigma for People with HIV Who Inject Drugs in Boston

A major source of continued HIV transmission is outbreaks of HIV in people who inject drugs. People with HIV who inject drugs (PHWID) face several barriers to consistent HIV viral suppression, in part due to psycho-behavioral sequelae of enacted, anticipated, and internalized stigma. To better support HIV medication adherence among PHWID, the views of stakeholders on optimal content and delivery strategies are needed.

Qualitative methods were used to solicit feedback from PHWID and other stakeholders on: unmet psycho-social needs among PHWID, selection of evidence-based strategies to address identified unmet needs, adaptation to content and delivery strategies for PHWID, as well as strategies to make psycho-behavioral efforts feasible and accessible to PHWID. Thematic analysis was used to analyze the results and feedback was iteratively integrated into the production of a psycho-behavioral intervention for PHWID.

Our research team conducted 20 semi-structured interviews with PHWID and stakeholders (e.g., addiction and infectious disease physicians and nurse practitioners, harm reductionists, community health workers) as well as three discussions with public health officials. Across interviews and discussions, we identified a consensus regarding unmet psycho-behavioral needs related to coping with anticipated and internalized stigma as well as assertive communication skills to increase self-advocacy. Participants also indicated needs for access to subsistence needs (e.g., housing) and strategies to overcome concrete barriers to care (e.g., inconsistent phone and internet access and limited transportation). Across interviews, participants conveyed a need for the intervention and the delivery methods to be flexible (i.e., language, duration, location) and for efforts to be invested in supporting phone access and transportation.

These results informed the adaptation of the iSTRIVE intervention content and delivery as well as parameterized flexibly in relation to duration and location. The iSTRIVE intervention is currently being delivered as the experimental component of a randomized controlled pilot trial in which all participants receive prepaid phones to complete incentivized directly observed therapy, an evidence-based intervention for antiretroviral adherence for PHWID. Engaging PHWID and other stakeholders in the development and adaptation of psycho-behavioral interventions has the capacity to bring evidence-informed strategies to PHWID, a profoundly underserved population.