Bay Area Reporter - July 20, 2001
David Fraser

People on HIV medications who use alcohol and/or recreational drugs are being recruited for an ongoing study designed to help them stick to their regimens.

You may have seen recruiting ads at bus shelters in the Castro, with a green butterfly held in a palm.

Called CHAT, for Challenges in HIV/AIDS Treatment, the study is designed in part to help people find ways to manage their lives and their HIV medications. Around 250 people are now participating in CHAT at the Center for AIDS Prevention Studies at the University of California, San Francisco. Another 250 are needed by next March.

There are three main criteria for the initial screening, according to CAPS' Michael Crosby, Ph.D., MPH, the principal investigator. Participants must:

1) currently be using alcohol and/or recreational drugs from ecstasy to heroin;

2) have a detectable viral load;

3) currently be on HIV medication.

The study is open to Bay Area residents, though it primarily targets San Franciscans because of the need for regular visits over a year to the CAPS offices near the Embarcadero.

Crosby, trained as a clinical psychologist, began AIDS work in 1989 with the AIDS Health Project; at CAPS, he researches high-risk groups including substance-using gay men. His co-investigator, Maria Ekstrand, Ph.D., also with UCSF, has developed peer-led prevention programs for junior high students in Oakland, Indonesia, and the Philippines.

Major problem areas

In preparing the study, Crosby told the Bay Area Reporter, "we came up with six major areas for substance-using men and women" that can make it hard to keep to a pharmaceutical regimen. These are: the medicines' side effects; a chaotic lifestyle; poor stress management; inadequate social support; poor interaction with health care providers; and struggles to remove a host of other barriers.

CHAT is testing whether individually tailored interventions can help people manage their meds. A recent study by Dr. David Bangsberg and colleagues at UCSF found that the more adherent people are to their HIV medication regimens (highly active antiretroviral therapy, or HAART), the slower they progress to AIDS. Bangsberg is consulting on CHAT.

People selected for the study will be split randomly into an intervention or a control group. The latter won't get the intervention, which consists in part of six individual counseling sessions.

There's a year-long commitment required. Both groups will be asked to return every four months for data collection about health and behavior, plus blood will be drawn.

People in the intervention group will have to visit CAPS' offices, near the Embarcadero, for weekly counseling sessions by a specialist in HIV medication adherence. There will be a total of six sessions over two months.

"The beauty of this intervention," said Crosby, "is that people will come with different problems. We address them where they're at, help them strategize better ways to overcome barriers. If they're not ready to roll with a strategy, we'll work with that.

"Let's say someone comes through [the program], he likes to use speed, and when he does, he doesn't take his meds. He clearly doesn't want to stop using speed. Our intervention helps him come up with ways to stick to the schedule.

"He and the counselor are going to figure out together what to do. The counselor isn't there to tell you what to do; the session is about getting participants to solve their own problems."

Crosby said one speed user who joined CHAT found he could set his Palm Pilot to go off when he needed to take his medications.

Some people use sticky notes, plastering them wherever there's daily routine. "Usually the bathroom and kitchen," Crosby said. "But some people have their meds packed in baggies and put them in their backpacks. If you have a cell phone, you can set it to buzz."

Not sticking exactly to a HAART regimen tends to produce resistant strains of virus, which can then be transmitted sexually to uninfected or infected partners, Crosby said.

"We know that if a person has at least 95 percent adherence to their medical regimen, they're more likely to have an undetectable viral load than someone at 90 or 85 percent," Crosby added. "It's not an absolute where 100 percent adherence means an undetectable viral load. We're trying to reduce viral load by increasing adherence.

"We can't demonstrate yet that that's what will happen; we'd like to see."

Participants will be paid, though Crosby declined to give specifics. Those wanting help for their alcohol or drug issues can get referrals.

For more information on the CHAT study, call (415) 597-9204. The Web site is www.caps.ucsf.edu/chat.
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