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Individual Oral Paper

Trauma and Stressor Related Disorders and Disasters

At the Intersection of HIV and Behavioral Health: Predictors and Outcomes Across the Care Cascade

6 - (IOP 21) Improvements in HIV Outcomes and PTSD Symptoms with an Integrated PTSD Treatment and Adherence Intervention (Cognitive Processing Therapy; CPT-L) for People with HIV (PWH)

Saturday, November 22, 2025
4:15 PM - 4:30 PM CST
Location: Celestin H, Level 3
Keywords: HIV / AIDS, PTSD (Posttraumatic Stress Disorder), Stigma
Recommended Readings: López, C.M., Baker, N., Moreland, A., Slick, N., Bisca, E., Eckard, A., Madisetti, M., Resick, P., Safren, S., Danielson, C. (2023). Development and Feasibility Testing of an Integrated PTSD and Adherence Intervention Cognitive Processing Therapy-Life steps (CPT-L) to Improve HIV Outcomes: Trial Protocol. Contemporary Clinical Trials Communications, 33, 101150. doi: 10.1016/j.conctc.2023.101150,   ,   ,   ,  
Despite high rates of PTSD in persons with HIV (PWH) and poor HIV-related health outcomes associated with PTSD, an effective evidence-based treatment for PTSD symptoms in PWH has not been tested. Stigma attached to HIV, mental health, and minoritized identities are another major barrier to retention in HIV care. Cognitive Processing Therapy (CPT) is an evidence-based PTSD treatment, which we made targeted modifications to, with the goal of reducing PTSD symptoms to facilitate improvement from antiretroviral therapy (ART) adherence counseling and subsequent viral suppression. This was the first pilot RCT to test feasibility of an integrated evidence-based PTSD treatment (CPT) with an adherence intervention (Lifesteps) to improve PTSD symptoms and HIV care outcomes. Participants were 41 adults with HIV, co-occurring PTSD, and areas of improvement in HIV care (e.g., missed appointments, less than 90% ART adherence, detectable viral load); they were randomized to the CPT-L intervention (n=20) or the comparison condition of Lifesteps only (n=21). Outcomes including PTSD symptoms, HIV stigma, quality of life, and electronic medical review (EMR; e.g., viral load, attendance) were collected at baseline, post-intervention, and a 3-month follow-up visit. Data from the feasibility trial demonstrated expected reductions in PTSD symptoms, HIV internalized stigma, and improvements in HIV care. Univariable analysis of participants with available end of treatment data indicated those randomized to receive CPT-L had a greater decrease in total scores on the Clinician-Administered PTSD Scale (CPT-L= -17.7 (2.4) vs. Lifesteps alone= -6.2 (4.0), Δ=11.6 (4.3), p=.013). CPT-L participants also reported significantly greater reductions in HIV stigma (p <.05 on all subscales) and statistically greater quality of life (QOL) as measured by the HIV-QOL Brief for HIV patients. With regard to HIV care, a larger proportion of participants in the Lifesteps only condition (85.7%) “No-Showed” at least one appointment with their ART prescribing provider, compared to 69.2% of those in the CPT-L group. Similarly, a larger proportion of CPT-L participants (93.3%) were virally suppressed at end of treatment than those in Lifesteps (76.92%; Fisher’s p=.31). For ART adherence, CPT-L participants had higher median percentage of doses taken (99.4%) compared to Lifesteps participants (73.1%; Wilcoxon Rank Sum Test of p = .19). While there were sample size limitations to consider, this preliminary data is promising and warrants further investigation. This research extends PTSD treatment approaches as a paradigm to reduce common barriers to ART adherence like PTSD symptoms and stigma. Implementing tailored PTSD treatment for PWH as a means of addressing HIV care is an innovative use of established behavioral interventions and can help improve HIV outcomes.

Learning Objectives:

At the end of this session, the learner will be able to:
  1. Describe effects of PTSD on HIV care outcomes.