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 ( Δ  = 11.55, SE  = 4.32, Cohen’s d  = 1.03, p  = .01) and HIV stigma ( Δ  = 22.63, SE  = 7.33, p = 0.006, Cohen’s d  = 1.37) in participants randomized to CPT-L compared to Lifesteps-only. Preliminary data also indicate promising findings in HIV care (e.g., improved appointment rates, overperformance on viral load and ART adherence) for individuals in the CPT-L group. 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.