Adolescents and young adults are more likely to newly acquire HIV infections than other age groups. This young cohort is also less likely to access medical care, adhere to antiretroviral therapy, or achieve viral suppression when compared to older age cohorts.
Sibinga et al. [AIDS Care] evaluated whether Mindfulness-Based Stress Reduction (MBSR) could increase medication compliance and help reduce HIV viral load in adolescents and young adults living with HIV infection.
The researchers randomly assigned 74 HIV positive adolescents and young adults aged 13-24 (average age = 21; 92% Black) to MBSR, health education, or medical treatment as usual. The MBSR program included 8 weekly 2-hour sessions and a 3-hour retreat. MBSR content was modified to make it more relevant to urban youth.
The 8-week health education control was matched to MBSR in terms of the length and frequency of meetings and group size. It offered didactic information on physical activity, nutrition, weight, and personal care. Treatment as usual consisted of clinic visits and lab work every 3-6 months.
Data analysis showed no significant differences between the health education (N=32) and treatment as usual (N= 8) groups on any variables, and so the groups were combined as a single control group to compare against the MBSR group. While this was not the original plan for the trial, it added more power to compare MBSR to a study control group.
Average MBSR attendance was 6 sessions with 5 participants attending no sessions. Average health education attendance was 5 sessions with 7 participants attending no sessions.
Participants were assessed at baseline, post-treatment, and 6- and 12-month follow up on medication adherence (as measured by a self-report questionnaire of pills prescribed and taken and of missed doses per week), HIV viral load, and CD4 cell counts. Viral load is a measure of the presence of the virus in the bloodstream. CD4 count is a measure of cellular-based immunity. Higher viral load and lower CD4 count are indicators of disease progression.
Within-group results showed participants in both MBSR and the combined control group attained significantly higher rates of medication adherence at post-treatment (OR = 1.81) and 6-month follow-up (OR = 3.95) than at baseline. The MBSR group had a significantly greater increase in medication adherence at post-treatment than the control group (OR = 2.50). This relative improvement did not persist at 12 months.
At immediate post-treatment, there was a trend toward a greater MBSR HIV viral load decrease compared to the control group. This trend became significant when only participants who attended at least one intervention session were included in the analysis. CD4 levels were unchanged in both groups after the intervention.
The study shows a MBSR program modified to meet the needs of urban youth can significantly improve antiretroviral medication adherence for up to six months relative to a health education intervention. The study is limited by its reliance on a self-report measure of medication adherence given the limitations of human recall of taking pills as well as reporting bias.
Sibinga, E. M. S., Webb, L., Perin, J., Tepper, V., Kerrigan, D., Grieb, S., Denison, J., & Ellen, J. (2022). Mindfulness instruction for medication adherence among adolescents and young adults living with HIV: A randomized controlled trial. AIDS Care.
Link to study