Mindfulness to improve art adherence and acceptance in youth living with HIV: An RCT

Background: Individuals 13-24 years old make up an alarming and disproportionate 21% of new HIV diagnoses. Unfortunately, this age group is less engaged in care and only half as likely to achieve HIV viral suppression (seen in only 30%) than older individuals, leading to significant vulnerability to illness and limiting broader efforts to end the HIV epidemic Methods: Our previous research found that mindfulness programming for HIV-infected youth was promising, showing improved coping, life satisfaction, and potentially decreased HIV viral load. This NIH-funded RCT aimed to further explore the effect of evidence-based mindfulness-based stress reduction (MBSR) vs. health education control (HT) on HIV medication adherence in HIV-infected youth. Data were collected at baseline, 3, 6, and 12 months. Generalized linear additive modeling was conducted to determine differences by arm over time. In-depth interviews were conducted with 20 individuals from both study arms at baseline and follow-up. Results: Seventy-four 13-24 year old participants from medical clinics at two major academic centers completed baseline data collection and were randomized to MBSR or HT. Following program participation, MBSR participants had greater increases in medication adherence (p=0.001) and greater decline in HIV viral load (p=0.052) at 3-month follow-up, but not at 6 or 12 months. Qualitative data describe challenges of managing HIV as a stigmatized, chronic condition, amidst significant stressors and social inequalities. MBSR participants perceived program benefit related to social support and to their enhanced capacity to non-judgmentally observe and accept difficult thoughts, feelings, and experiences associated with living with HIV, which they believe facilitated greater medication adherence. Conclusion: This mixed-methods RCT finds that MBSR participants had larger increase in self-reported medication adherence and reduction in HIV viral load following program participation, but not at follow-up. Also, MBSR participants perceive greater capacity for acceptance of the complex and difficult thoughts and emotions related to living with HIV, leading to improved medication adherence. Given the significant vulnerability of this population and the importance of achieving higher rates of HIV viral suppression to decrease transmission and end the HIV epidemic, MBSR remains a promising approach to enhance the treatment of HIV-infected youth and young adults.