Eighty-six percent of individuals who entered HIV care soon after diagnosis maintained viral suppression after 48 weeks during a clinical trial conducted at four National Institutes of Health (NIH)-funded Centers for AIDS Research (CFARs) across the United States. Participants in the clinical trial, called iENGAGE, achieved viral suppression in an average of just 63 days. The findings were presented in a poster at the Conference on Retroviruses and Opportunistic Infections (CROI 2019) in Seattle.
The findings from iENGAGE, which was funded by NIH’s National Institute of Allergy and Infectious Diseases (NIAID), underscore the benefits of linking people with HIV to treatment services soon after diagnosis and highlight the importance of efforts to engage all people with HIV in care. Provision of effective HIV treatment resulting in sustained viral suppression is a critical component of efforts to end the HIV epidemic in the United States.
Notably, many iENGAGE participants had other medical conditions and unmet basic needs that can make adherence to medical visits and daily antiretroviral therapy (ART) difficult. About half of the study participants reported needing supportive services, including assistance with housing, employment, food and transportation. Mental health issues were also prevalent, with 31 percent of participants having depression and 30 percent having anxiety. Roughly one-third of participants reported high-risk alcohol use, and 18 percent reported substance use.
“Even when facing many other challenges in their lives, the majority of people engaged in HIV care can achieve viral suppression, benefiting their health and preventing transmission of the virus to others,” said NIAID director Anthony S. Fauci, MD. “To end the HIV epidemic in the United States, we must ensure that effective HIV prevention and treatment strategies are accessible to all who need them, especially in the areas of the country with the highest HIV burden.”
The iENGAGE trial was conducted at clinical trial sites in Baltimore; Seattle; Birmingham, Alabama; and Chapel Hill, North Carolina, participating in the CFAR Network of Integrated Clinical Systems (CNICS). Ten years ago, these sites recorded an approximately 60 percent rate of viral suppression among people new to HIV care.
The iENGAGE trial was designed to evaluate a behavioral intervention aimed at educating people newly diagnosed with HIV and reinforcing the importance of adherence to care. The 371 participants were enrolled within 14 days of initiating HIV medical care and randomly assigned to receive either the behavioral intervention plus standard care or standard care alone. The intervention, which combined two established approaches to enhance HIV medical visit adherence and ART adherence, comprised four in-person counseling sessions tailored to participants’ individual needs, as well as phone support, during the first 48 weeks of treatment.
