Outlook: Newsletter of the Society of Behavorial Medicine

Fall 2020

Optimizing the New Normal: Pivoting an In-Person Trauma and Syndemic-responsive HIV Care Intervention to a Virtual Platform in the era of COVID-19

Jamila K. Stockman, PhD, MPH‚úČ; Katherine M. Anderson, MPH; Sara Giovanna Carr, LMFT, MA; Marylene Cloitre, PhD; and Laramie R. Smith, PhD; HIV and Sexual Health SIG

Like HIV, the novel COVID-19 pandemic is disproportionately impacting people of color1 and invoking new HIV care challenges.2 In the US, women living with HIV/AIDS (WLHA) are already less likely than men to adhere to antiretroviral therapy (ART) and be virally suppressed,3,4 with women of color particularly affected.4 Syndemic (e.g., co-occurrence of violence, trauma, substance use, and poor mental health)5,6 and socio-structural (e.g., medical mistrust, stigma, social isolation)7-14 barriers exacerbate poor HIV care outcomes.15,16 To address this gap, we implemented the BRIDGES program in 2019, an in-person peer navigation intervention for syndemic-affected WLHA.

The BRIDGES program harnesses evidence-based trauma-informed psychoeducation, and is designed to build skills to cope with syndemic-related affective distress and activate social support networks. The ultimate goal is to improve retention in HIV care and ART adherence among syndemic-affected WLHA. BRIDGES participants take part in weekly in-person one-on-one peer navigation sessions with a WLHA-peer navigator experienced with accessing HIV care, coupled with 6 weeks of 2-hour psychoeducation group sessions co-facilitated by a peer navigator and licensed clinical therapist. Group sessions addressed topics relevant to WLHA’s lives, spanning from emotional awareness/regulation to relationship building.

One month post-implementation, the COVID-19 pandemic abruptly fell upon us, requiring an adjustment to a new normal – and a pivot in our tactic to support WLHA. The university issued an immediate directive to halt all in-person research- a logical public health response. Yet, ending intervention activities with BRIDGES participants could have resulted in harm, particularly in the context of a pandemic: increased social isolation, depressive symptoms, substance use, and violence already exacerbated by COVID-1917,18 could be compounded by the removal of services and support BRIDGES provides. We found ourselves balancing risk of COVID-19 with the principle of beneficence, to “maximize possible benefits while minimizing possible harms.”19 Ultimately, it was our due diligence to transition BRIDGES from the in-person format to a web-based virtual platform. Within one week, peer navigation one-on-one sessions occurred through phone, text, or Zoom video, while psychoeducation support group sessions and survey assessments (baseline, 3- and 6-month follow-up) occurred through Zoom video. BRIDGES staff prepared participants by holding introductory Zoom video-based sessions one day prior to their first “BRIDGES virtual session”, allowing women to become familiar with the technology and technical issues to be resolved.

We found the pivot from in-person to a virtual-based format has been acceptable, feasible, and well-received by participants. Participants have shared that the virtual format is easy, convenient, fits into their routine, and allows for more social connections without additional effort or risk- even to the extent of preferring the virtual format over the in-person format. Virtual sessions mitigated the anxiety syndemic-affected WHLA experience when having to leave home or get ready to meet people, a barrier preventing them from participating in in-person intervention programs. Taken together, the virtual format circumvents social isolation, fosters social support, and addresses barriers to in-person peer navigation-social support approaches. The COVID-19 pandemic is challenging; but, this pivot to innovation may prove a new and better way to support syndemic-affected WLHA.

For more information about the BRIDGES program and our syndemic and trauma related HIV research please contact Jamila K. Stockman, PhD, at jstockman@health.ucsd.edu or visit our study websites at https://istriveresearchlab.com.



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