The impact of prolonged exposure therapy on medication adherence and quality of life in people living with HIV: A randomized controlled trial

People living with HIV (PLWH) display disproportionally high levels of psychopathology (i.e., posttraumatic stress disorder symptoms [PTSS] and depressive symptoms) that may interfere with optimal medication adherence and health-related quality of life (HR-QOL). The adverse consequences of non-adherence and diminished HR-QOL, including reduced length of survival, highlight the need for intervention in PLWH. Though recent research suggests that the removal of psychological barriers (i.e., PTSS and depressive symptoms) may result in improvements in adherence and HR-QOL, this has never been directly tested in PLWH. We previously demonstrated the success of prolonged exposure (PE) therapy at improving PTSS and depressive symptoms in PLWH. The proposed study extends these findings by determining whether PE also impacted self-reported and electronically monitored medication adherence, and self-reported adherence self-efficacy, physical health symptoms, and HR-QOL in 65 PLWH. Participants were randomly assigned to either the PE (n = 40) or weekly monitoring/wait-list control group (n = 25), and completed assessments at baseline, post-treatment, and 3-months post-treatment. Following the 3-month assessment, control group participants were offered the intervention, and all PE recipients completed the 6-month assessment. Multilevel growth curve models were conducted on the completer and intent-to-treat samples using the HLM software, and exploratory mediation analyses were conducted in SPSS. Compared to the controls, PE recipients did not experience direct benefits in self-reported or electronically monitored medication adherence or HR-QOL throughout 3-months post-intervention; however, physical health symptoms improved for participants in both groups, and PE recipients reported increased adherence self-efficacy throughout 3 months. Mediation analyses further demonstrated that the removal of psychological barriers led to better short-term adherence and health