Engaging, Retaining, and Providing Transdiagnostic Integrated Cognitive-Behavioral Therapy and Motivational Interviewing for Underserved People With HIV

People with HIV experience elevated levels of co-occurring psychosocial concerns, which can interfere with HIV-related self-care behaviors, such as medication adherence. We recently developed transdiagnostic, integrated cognitive-behavioral therapy and motivational interviewing psychotherapy to address interrelated psychosocial problems (syndemics) that can interfere with medication adherence and self-care among people with uncontrolled HIV (i.e., a detectable viral load). Through completion of a field trial that included development, clinical supervision, treatment, and administrative coordination of this project, we identified recommendations for engaging, retaining, and delivering transdiagnostic cognitive-behavioral therapy/motivational interviewing to individuals with HIV and experiencing psychosocial and structural barriers to mental and physical health. We describe these recommendations, which include (a) building the relationship; (b) addressing HIV in the context of syndemics; (c) attending to the impact of stigma on health; (d) being flexible in delivering the treatment; (e) managing emergent crises with relevant skill material; (f) tailoring the treatment to education, language, and sociocultural context; (g) implementing problem-solving skills for structural barriers; (h) scheduling flexibly and following up; (i) colocating mental health services and coordinating among providers; and (j) providing a comfortable and affirming physical space. In addition to describing these recommendations, we provide clinical examples and highlight empirical research to illustrate and support using these recommendations. Clinical Impact Statement Question: What strategies can therapists use to engage, retain, and provide transdiagnostic, integrated cognitive-behavioral therapy and motivational interviewing to underserved clients with HIV? Findings: For therapists working with underserved clients with HIV, there are strategies that may increase clients' likelihood of using and staying in transdiagnostic CBT/MI treatment and can help to ensure that treatment is useful and relevant to clients' lives. Meaning: Despite the psychosocial, interpersonal, and structural challenges facing underserved clients with HIV, a variety of strategies may improve engagement and delivery of evidence-based mental health services using the strategies identified and may help to offset the impact of these challenges on clients' health and well-being. Next Steps: Future research might co