Background: HIV infection in the United States (US) is increasingly concentrated among men who have sex with men (MSM), particularly MSM of color. To achieve the goals of “Ending the HIV Epidemic: A Plan for America,” everyone living with HIV, including MSM, must be identified, linked to care and supported so that they achieve and maintain viral suppression for their own health and to prevent onward HIV transmission.
Methods: MSM who were living with HIV and virally unsuppressed were recruited in four US cities (Birmingham, AL, Atlanta, GA, Baltimore, MD, and Boston, MA) and were randomized to either an enhanced case management (CM) intervention or standard of care (SOC). The CM intervention had three components: access to a CM and referral services, counseling using motivational interviewing techniques, and automated adherence and motivational messaging. Critically, participants determined intervention intensity by choosing frequency and content of CM interactions and automated messaging. Viral suppression (< 200 copies/mL) across arms was compared at Month 12 using logistic regression. Those who did not provide a 12-month sample (aside from deaths) were treated as unsuppressed.
Results: 1305 MSM were screened; 154 were living with HIV and unsuppressed; 144 were enrolled. 91% were retained at Month 12. The enrolled cohort was 84% Black, 7% Latinx and the average age was 39. Most were educated (90%≥ high school diploma), but not employed (67%), with an income below $20,000 (64%). 81% had health insurance. The majority (86%) were ART experienced by self‑report. At baseline, the median viral load was 19,459 copies/mL, and at Month 12, 48% were virally suppressed, with no difference between the CM and SOC arms (OR = 0.615 [p = 0.1526, 95% CI = 0.315, 1.197]).
Conclusions: HPTN 078 demonstrated that MSM living with HIV, but out of care, are willing to re-engage when reached, with nearly half achieving and maintaining viral suppression at 12 months. The CM intervention did not, however, enhance viral suppression; half of the men, overall, were not virally suppressed at 12 months. Greater investment for more intensive interventions is likely needed to address the multiple societal and behavioral challenges among disenfranchised MSM in the US.