Can Remotely Delivered Interventions Increase Viral Suppression and Improve Quality of Life for Rural Adults Over 50 Living with HIV?

A recent study by Walsh and colleagues aimed to evaluate the acceptability, feasibility, and preliminary impact of four remotely-delivered interventions designed for rural adults older than 50 years of age living with HIV in the southern United States.

People living with HIV in rural areas face more difficulties accessing health care and experience higher mortality rates compared with those in non-rural areas. People living with HIV who are older than 50 years of age face even greater challenges due to the combined effects of aging, HIV-related health issues, and geographic isolation. Despite these barriers, few interventions specifically target this vulnerable group to improve their health outcomes and quality of life.

To address this gap, the researchers conducted a pilot study to test the impact of four different interventions: group-based social support, group-based stigma-reduction, individual strengths-based case management, and individual technology detailing. The goal of these interventions was to improve care engagement and overall quality of life for rural adults 50 years of age or older living with HIV.

A total of 61 participants (average age of 58, with 75% being male) were enrolled in the study. They were randomized to receive between 0 to four of these interventions and were assessed during a 3-month period. Participants completed surveys and self-collected blood samples at the beginning of the study and again at the end of the 3 months.

The researchers evaluated the feasibility and acceptability of the interventions by tracking participation rates and gathering feedback from participants. More than 80% of the participants engaged in the interventions assigned to them, and 84% completed the study in its entirety. The interventions were highly acceptable to participants, with more than 80% indicating they would recommend them to others. Specifically, the social support and case management interventions were seen as particularly relevant and enjoyable by the participants.

In terms of preliminary impact, the interventions showed promising effects on several key health outcomes. Improvements were observed in participants' quality of life, medication adherence, and depressive symptoms. There were also positive effects on internalized stigma and feelings of loneliness, suggesting that the interventions helped participants not only manage their HIV but also address the psychological and social challenges they face.

"We found promising preliminary impact of interventions on quality of life, medication adherence, depressive symptoms, internalized stigma, and loneliness," the authors concluded. "Remotely delivered interventions targeting rural older PLH are feasible to conduct and acceptable to participants. Larger scale study of these interventions is warranted."

Reference
Walsh JL, Quinn KG, Hirshfield S, et al. Acceptability, feasibility, and preliminary impact of 4 remotely-delivered interventions for rural older adults living with HIV. AIDS Behav. 2024;28(4):1401-1414. doi: 10.1007/s10461-023-04227-5.