Integrated PTSD and Adherence Treatment for People with HIV: Main Findings of a Feasibility Pilot for Cognitive Processing Therapy-Lifesteps (CPT-L).

Background: Despite high PTSD prevalence and related detrimental health outcomes for persons with HIV (PWH) there are no established integrated interventions addressing co-occurring HIV and PTSD. Negative reinforcement conceptual models posit that avoidant behavior (a hallmark symptom of PTSD) demonstrated by PWH with co-occurring PTSD can contribute to poor antiretroviral therapy (ART) adherence. However, research evaluating the impact of evidence-based treatment for PTSD among HIV positive populations on HIV outcomes is scarce. The Cognitive Processing Therapy (CPT) protocol is an evidence-based PTSD treatment that can address internalized stigma with tailored modifications and improve ART adherence and subsequent viral suppression through reduction of avoidant coping. Methods: This is the first pilot RCT to test feasibility of an integrated evidence-based PTSD treatment, cognitive processing therapy (CPT) with an adherence intervention (Life-steps) delivered in a Ryan White clinic to improve PTSD symptoms and HIV care. Participants were 41 adults with HIV, co-occurring PTSD, and areas of improvement in HIV care (e.g., missed appointments, less than 90% ART adherence, detectable viral load). Those meeting eligibility criteria were enrolled and randomized to the CPT-L intervention (n = 20) or the control condition of Life-steps only (n = 21). Outcome measures including PTSD symptoms, HIV stigma, quality of life, viral load, and engagement in care appointments were collected at baseline, post-intervention and at a 3-month follow-up visit. Results: Data from the feasibility trial demonstrated significantly greater reductions in PTSD symptoms ( Conclusions: The research extends PTSD treatment approaches as a paradigm to integrate adherence counseling and improve ART adherence. This is an innovative use of established behavioral interventions and supports the U = U (Undetectable = Un-transmissible) campaign, potentially helping prevent the transmission of HIV through increasing viral suppression rates in a people living with HIV and PTSD.The study was registered with clinicaltrials.gov, identifier NCT05275842.