An Exploratory Behavioral Intervention Trial to Improve Rates of Screening for AIDS Clinical Trials Among Racial/Ethnic Minority and Female Persons Living with HIV/AIDS

Abstract

Individuals from racial/ethnic minority backgrounds and women have not been proportionately represented in AIDS clinical trials (ACTs). There have been few intervention efforts to eliminate this health disparity. This paper reports on a brief behavioral intervention to increase rates of screening for ACTs in these groups. The study was exploratory and used a single-group pre/posttest design. A total of 580 persons living with HIV/AIDS (PLHA) were recruited (39% female; 56% African-American, 32% Latino/Hispanic). The intervention was efficacious: 25% attended screening. We identified the primary junctures where PLHA are lost in the screening process. Both group intervention sessions and an individual contact were associated with screening. Findings provide preliminary support for the intervention's efficacy and the utility of combining group and individual intervention formats. Interventions of greater duration and intensity, and which address multiple levels of influence (e.g., social, structural), may be needed to increase screening rates further.

Minorities Remain Underrepresented in HIV/AIDS Research Despite Access to Clinical Trials

“…1,2,3,4 The reasons for minority underrepresentation in clinical research are varied and complex; some of them are common to all minority groups (i.e. lack of information and access to trials, provider bias on adequacy of trial enrollment, competing family and financial priorities, low levels of education, lack of health insurance and negative family and community opinions about research), 3,5 while others are specific to a certain minority groups (i.e. mistrust from African-American community, language barriers in Hispanic immigrants).…”

Predictors of Screening for AIDS Clinical Trials Among African-Americans and Latino/Hispanics Enrolled in an Efficacious Peer-Driven Intervention: Uncovering Socio-Demographic, Health, and Substance Use-Related Factors That Promote or Impede Screening

“…Nationally, African American PLHA have the greatest barriers to ACTs, including low rates of recruitment into ACTs by providers and health care settings, high levels of medical mistrust, and also the highest rates of under-representation in ACTs of any racial/ethnic group [1–3]. On the other hand, past research indicates that African Americans are willing, at least in theory, to participate in ACTs if asked [3,8,39]. Although researchers and providers often assume African American PLHA are not interested in ACTs [11], the present study indicates they are highly amenable to screening in the context of a culturally targeted intervention, and as likely to do so as Latinos, even though Latinos are considered to have fewer barriers to ACTs.…”

“…First, they are less likely to be invited to screen by providers, clinical settings, and clinical trials sites. Then, when asked, they may be more likely to decline to screen or enroll than their White peers, or, if they do screen, they are more likely to face serious social, structural, and individual barriers to completing screening and enrolling into trials compared to their White peers, as this is a complex and lengthy process [8,57]. Thus, clinic and clinical trials sites have the potential to greatly reduce racial/ethnic disparities in ACTs by offering all patients regular and repeated access ACT screening, regardless of their potential eligibility or perceived interest [13], implementing interventions such as the ACT2 PDI to build patients’ motivation and capabilities to screen for and join ACTs, and ameliorating the socio-demographic and other factors identified in the present paper during the screening and enrollment process in order to further increase access to ACTs for PLHA of color.…”

“…This low enrollment of people of color in ACTs raises questions about the applicability of research findings to the populations most affected by HIV/AIDS, and denies individual PLHA of color the opportunity to contribute to and possibly benefit from participation in biomedical studies and trials [6,7]. Although the range of barriers that PLHA of color experience in accessing ACTs has been described in the literature [8–11], including individual-, social-, and structural-level impediments, intervention efforts have only recently been directed toward this health disparity. Screening is the first step in the process of enrolling in ACTs [12].…”

Current and Emerging Research Needs in Studying the NYC HIV–Drug Use Epidemic

“…In addition, increased research efforts are needed in how to recruit, engage, and support drug users in AIDS clinical trials, both to improve the generalizability of research findings and to ensure that drug users have access to the high level of care and attention and new treatments available through clinical trials (Gwadz, Cylar, et al, 2010; Gwadz, Leonard, et al, 2010). Innovative efforts that integrate HIV and drug treatment require further development and testing (Cunningham et al, 2011; Strauss & Mino, 2011).…”