Enhancing Communication and HIV Outcomes (ECHO)

The goal of this research is to improve communication between the patients with HIV and their health care providers. The overall purpose of doing so is to reduce disparities in medication self-efficacy, adherence to therapy, and HIV viral load suppression. The investigators will conduct a randomized controlled trial to test the effectiveness of a combined provider and patient communication intervention conducted at two separate visits compared to usual care in improving the quality of patient-provider communication, patients' medication self-efficacy, patient adherence to therapy, and HIV RNA suppression.

The goal of this research is to improve communication between the patients with HIV and their health care providers. The overall purpose of doing so is to reduce disparities in medication self-efficacy, adherence to therapy, and HIV viral load suppression. We will conduct a randomized controlled trial to test the effectiveness of a combined provider and patient communication intervention conducted at two separate visits compared to usual care in improving the quality of patient-provider communication, patients' medication self-efficacy, patient adherence to therapy, and HIV RNA suppression. The following primary and secondary hypotheses will be addressed. Primary Hypothesis. 1) There will be more and higher quality patient-provider communication about antiretroviral medication adherence in the intervention compared to control arm at both visit 1 (V1) and visit 2 (V2). Secondary Hypotheses Higher quality patient-provider communication in the intervention arm will be associated with higher patient ratings of communication (overall, HIV-specific, adherence-specific, and interpersonal style of provider) at V1 and V2; increased patient preference for a shared decision-making role at V1 and V2; more positive health beliefs at V1 and V2; higher patient medication self-efficacy at V1 and V2; better adherence to antiretroviral medication (assessed by 3-day recall) at V2; and a greater percentage of patients with HIV-1 RNA suppression at V2. The intervention will reduce disparities in medication self-efficacy, adherence, and HIV-1 RNA suppression.

providers are trained to communicate with patients about adherence and patients are coached to discuss adherence with providers

providers are trained to communicate with patients about adherence and patients are coached to discuss adherence with providers

Inclusion Criteria (Providers): Currently providing primary care to at least 10 HIV-infected patients in the clinic Physician, Nurse-Practitioner, or Physician-Assistant Agree to give written informed consent. Inclusion Criteria (Patients): HIV-infected patient of one of the participating providers Has had at least one prior visit with that provider Currently taking antiretroviral therapy Capable of understanding and giving written informed consent Age > 20 years old English-speaking African-American (or people of African descent living in the United States), Hispanic, or non-Hispanic White race/ethnicity