Abstract
BACKGROUND: People living with Human immunodeficiency virus (HIV; PLHIV) have high rates of post-traumatic stress disorder (PTSD), which contributes to poor health outcomes. Avoidant behavior, a hallmark feature and overlapping symptom of PTSD and HIV stigma, may undermine antiretroviral therapy (ART) adherence. Few studies have evaluated PTSD treatment effects on HIV outcomes. Cognitive Processing Therapy (CPT), an evidence-based PTSD treatment, can be adapted to address internalized stigma and adherence by reducing avoidance. In alignment with the U = U (Undetectable = Untransmissible) campaign, this pilot randomized controlled trial (RCT) tested feasibility of integrating CPT with an adherence intervention (Life-steps; CPT-L) in a Ryan White clinic. METHODS: Forty-one adults with HIV, PTSD, and suboptimal HIV care (e.g., missed appointments, detectable viral load) were recruited from a South Carolina Ryan White clinic. Participants were randomized 1:1 to CPT-L (n = 20) or Life-steps only (n = 21). Outcomes included PTSD symptoms, HIV stigma, quality of life, viral load, and appointment engagement, assessed at baseline, post-intervention, and 3-month follow-up. Analyses used linear regression/ANOVA, with viral load detection examined via Fisher's exact test. RESULTS: CPT-L participants showed significantly greater reductions in PTSD symptoms (Δ = 11.55, SE = 4.32, p = .01) and HIV stigma (Δ = 22.63, SE = 7.33, p = .006) compared with Life-steps only. Preliminary trends also indicated improved HIV care indicators, including appointment attendance, ART adherence, and viral suppression. CONCLUSIONS: Integrating CPT with adherence counseling reduced PTSD symptoms and HIV stigma, and showed potential to improve HIV outcomes. This innovative approach may advance U = U goals by increasing viral suppression among PLHIV with PTSD.