Resum
BACKGROUND: Worldwide optimal adherence to antiretroviral therapy (ART) among men who have sex with men (MSM) living with HIV is still a challenge to reduce HIV transmission. Mental health problems are one of the most significant barriers to ART adherence among MSM living with HIV. Although multiple interventions have been implemented around the world, almost none have shown consistent effects in the long term. METHODS: From November 2017 to January 2020, we implemented a multicenter, parallel, randomized controlled trial of the intervention 'FUERTES' with 151 MSM receiving ART in three HIV clinics in Mexico. The objective of the intervention was to improve ART adherence among MSM initiating treatment and measure health outcomes at one, four, and ten months. The intervention group received FUERTES for a maximum of six months. We evaluated adherence using medication possession ratio, self-report through the AACTG questionnaire, CD4 count, and viral load. We assessed mental health using various questionnaires: the PHQ-9 for depression, the AUDIT for alcohol abuse, and the DAST-10 for addiction to drugs. We performed a descriptive analysis. Baseline and follow up characteristics were compared between the two groups applying t-test and chi-square test as appropriate. Mental health outcomes were expressed as percentages and described the trends over the study period. RESULTS: We found no differences regarding ART adherence between groups. However, at four months, 20.55% of the control group participants reported having a moderate to severe depression compared to 5.6% of the intervention group (p=0.008), and 18.84% vs. 7.35% respectively at ten months (p=0.047). Regarding drug abuse, 10.96% of the control group participants reported having a considerable high drug consumption at four months, compared to 1.41% of the intervention group (p=0.018). We did not find any differences in baseline CD4 count, viral load, or socioeconomic characteristics.
CONCLUSIONS: FUERTES has the potential to improve medium-term mental health and substance abuse outcomes of MSM living with HIV in Mexico. Although our intervention did not have a direct impact on adherence outcomes, its effect on the participant's mental health might influence adherence in the long-term. Therefore, we will measure adherence in three years to identify any differences between groups.