1
|
Liang A, Wilson-Barthes M, Galárraga O. Cost-effectiveness of differentiated care models that incorporate economic strengthening for HIV antiretroviral therapy adherence: a systematic review. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2024; 22:46. [PMID: 38790050 PMCID: PMC11127452 DOI: 10.1186/s12962-024-00557-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 05/19/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND There is some evidence that differentiated service delivery (DSD) models, which use a client-centered approach to simplify and increase access to care, improve clinical outcomes among people living with HIV (PLHIV) in high HIV prevalence countries. Integrating economic strengthening tools (e.g., microcredit, cash transfers, food assistance) within DSD models can help address the poverty-related barriers to HIV antiretroviral therapy (ART). Yet there is minimal evidence of the cost-effectiveness of these types of multilevel care delivery models, which potentially prohibits their wider implementation. METHODS Using a qualitative systematic review, this article synthesizes the literature surrounding the cost-effectiveness of differentiated service delivery models that employ economic strengthening initiatives to improve HIV treatment adherence in low- and middle-income countries. We searched three academic databases for randomized controlled trials and observational studies published from January 2000 through March 2024 in Sub-Saharan Africa. The quality of each study was scored using a validated appraisal system. RESULTS Eighty-nine full texts were reviewed and 3 met all eligibility criteria. Two of the three included articles were specific to adolescents living with HIV. Economic strengthening opportunities varied by care model, and included developmental savings accounts, microenterprise workshops, and cash and non-cash conditional incentives. The main drivers of programmatic and per-patient costs were ART medications, CD4 cell count testing, and economic strengthening activities. CONCLUSION All economic evaluations in this review found that including economic strengthening as part of comprehensive differentiated service delivery was cost-effective at a willingness to pay threshold of at least 2 times the national per capita gross domestic product. Two of the three studies in this review focused on adolescents, suggesting that these types of care models may be especially cost-effective for youth entering adulthood. All studies were from the provider perspective, indicating that additional evidence is needed to inform the potential cost-savings of DSD and economic strengthening interventions to patients and society. Randomized trials testing the effectiveness of DSD models that integrate economic strengthening should place greater emphasis on costing these types of programs to inform the potential for bringing these types of multilevel interventions to scale.
Collapse
Affiliation(s)
- Annie Liang
- Brown University School of Public Health, Providence, RI, USA
| | - Marta Wilson-Barthes
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Omar Galárraga
- Department of Health Services, Policy and Practice; and International Health Institute, Brown University School of Public Health, 121 South Main Street, Box G-S121-2, Providence, RI, USA.
| |
Collapse
|
2
|
Novak MD, Holtyn AF, Toegel F, Rodewald AM, Leoutsakos JM, Fingerhood M, Silverman K. Long-Term Effects of Incentives for HIV Viral Suppression: A Randomized Clinical Trial. AIDS Behav 2024; 28:625-635. [PMID: 38117449 DOI: 10.1007/s10461-023-04249-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2023] [Indexed: 12/21/2023]
Abstract
Achieving viral suppression in people living with HIV improves their quality of life and can help end the HIV/AIDS epidemic. However, few interventions have successfully promoted HIV viral suppression. The purpose of this study was to evaluate the long-term effectiveness of financial incentives for viral suppression in people living with HIV. People living with a detectable HIV viral load (≥ 200 copies/mL) were randomly assigned to Usual Care (n = 50) or Incentive (n = 52) groups. Incentive participants earned up to $10 per day for providing blood samples with an undetectable or reduced viral load. During the 2-year intervention period, the percentage of blood samples with a suppressed viral load was significantly higher among Incentive participants (70%) than Usual Care participants (43%) (OR = 7.1, 95% CI 2.7 to 18.8, p < .001). This effect did not maintain after incentives were discontinued. These findings suggest that frequent delivery of large-magnitude financial incentives for viral suppression can produce large and long-lasting improvements in viral load in people living with HIV. ClinicalTrials.gov Identifier: NCT02363387.
Collapse
Affiliation(s)
- Matthew D Novak
- Department of Psychiatry and Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Suite 350 East, Baltimore, MD, 21224, USA
| | - August F Holtyn
- Department of Psychiatry and Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Suite 350 East, Baltimore, MD, 21224, USA
| | - Forrest Toegel
- Department of Psychiatry and Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Suite 350 East, Baltimore, MD, 21224, USA
| | - Andrew M Rodewald
- Department of Psychiatry and Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Suite 350 East, Baltimore, MD, 21224, USA
| | - Jeannie-Marie Leoutsakos
- Department of Psychiatry and Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Suite 350 East, Baltimore, MD, 21224, USA
| | - Michael Fingerhood
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kenneth Silverman
- Department of Psychiatry and Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Suite 350 East, Baltimore, MD, 21224, USA.
| |
Collapse
|
3
|
King K, McGuinness S, Watson N, Norton C, Chalder T, Czuber-Dochan W. What Do We Know about Medication Adherence Interventions in Inflammatory Bowel Disease, Multiple Sclerosis and Rheumatoid Arthritis? A Scoping Review of Randomised Controlled Trials. Patient Prefer Adherence 2023; 17:3265-3303. [PMID: 38111690 PMCID: PMC10725835 DOI: 10.2147/ppa.s424024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 09/13/2023] [Indexed: 12/20/2023] Open
Abstract
Purpose Between 53% and 75% of people with inflammatory bowel disease, 30%-80% with rheumatoid arthritis, and up to 50% with multiple sclerosis do not take medications as prescribed to maintain remission. This scoping review aimed to identify effective adherence interventions for inflammatory bowel disease, but with few studies found, multiple sclerosis and rheumatoid arthritis were included to learn lessons from other conditions. Methods Full and pilot randomised controlled trials testing medication adherence interventions for inflammatory bowel disease, multiple sclerosis, and rheumatoid arthritis conducted between 2012 and 2021 were identified in six electronic databases. Results A total of 3024 participants were included from 24 randomised controlled trials: 10 pilot and 14 full studies. Eight investigated inflammatory bowel disease, 12 rheumatoid arthritis, and four multiple sclerosis. Nine studies (37.5%) reported significantly improved medication adherence, all involving tailored, personalised education, advice or counselling by trained health professionals, with five delivered face-to-face and 1:1. Quality of effective interventions was mixed: five rated high quality, two medium and two low quality. Interventions predominantly using technology were likely to be most effective. Secondary tools, such as diaries, calendars and advice sheets, were also efficient in increasing adherence. Only 10 interventions were based on an adherence theory, of which four significantly improved adherence. Conclusion Tailored, face-to-face, 1:1 interactions with healthcare professionals were successful at providing personalised adherence support. Accessible, user-friendly technology-based tools supported by calendars and reminders effectively enhanced adherence. Key components of effective interventions should be evaluated and integrated further into clinical practice if viable, whilst being tailored to inflammatory conditions.
Collapse
Affiliation(s)
- Kathryn King
- Florence Nightingale Faculty Nursing, Midwifery and Palliative Care, King’s College London, London, UK
| | - Serena McGuinness
- Florence Nightingale Faculty Nursing, Midwifery and Palliative Care, King’s College London, London, UK
| | - Natalie Watson
- Florence Nightingale Faculty Nursing, Midwifery and Palliative Care, King’s College London, London, UK
| | - Christine Norton
- Florence Nightingale Faculty Nursing, Midwifery and Palliative Care, King’s College London, London, UK
| | - Trudie Chalder
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Wladyslawa Czuber-Dochan
- Florence Nightingale Faculty Nursing, Midwifery and Palliative Care, King’s College London, London, UK
| |
Collapse
|
4
|
Buh A, Deonandan R, Gomes J, Krentel A, Oladimeji O, Yaya S. Barriers and facilitators for interventions to improve ART adherence in Sub-Saharan African countries: A systematic review and meta-analysis. PLoS One 2023; 18:e0295046. [PMID: 38032918 PMCID: PMC10688728 DOI: 10.1371/journal.pone.0295046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 11/14/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND The HIV/AIDS pandemic remains a significant public health issue, with sub-Saharan Africa (SSA) at its epicentre. Although antiretroviral therapy (ART) has been introduced to decrease new infections and deaths, SSA reports the highest incidence of HIV/AIDS, constituting two-thirds of the global new infections. This review aimed to elucidate the predominant barriers and facilitators influencing ART adherence and to identify effective strategies to enhance ART adherence across SSA. METHODS A comprehensive review was conducted on studies examining barriers to ART adherence and interventions to boost adherence among HIV-positive adults aged 15 and above in SSA, published from January 2010 onwards. The research utilized databases like Medline Ovid, CINAHL, Embase, and Scopus. Included were experimental and quasi-experimental studies, randomized and non-randomized controlled trials, comparative before and after studies, and observational studies such as cross-sectional, cohort, prospective and retrospective studies. Two independent reviewers screened the articles, extracted pertinent data, and evaluated the studies' methodological integrity using Joanna Briggs Institute's standardized appraisal tools. The compiled data underwent both meta-analysis and narrative synthesis. RESULTS From an initial pool of 12,538 papers, 45 were selected (30 for narrative synthesis and 15 for meta-analysis). The identified barriers and facilitators to ART adherence were categorized into seven principal factors: patient-related, health system-related, medication-related, stigma, poor mental health, socioeconomic and socio-cultural-related factors. Noteworthy interventions enhancing ART adherence encompassed counselling, incentives, mobile phone short message service (SMS), peer delivered behavioural intervention, community ART delivery intervention, electronic adherence service monitoring device, lay health worker lead group intervention and food assistance. The meta-analysis revealed a statistically significant difference in ART adherence between the intervention and control groups (pooled OR = 1.56, 95%CI:1.35-1.80, p = <0.01), with evidence of low none statistically significant heterogeneity between studies (I2 = 0%, p = 0.49). CONCLUSION ART adherence in SSA is influenced by seven key factors. Multiple interventions, either standalone or combined, have shown effectiveness in enhancing ART adherence. To optimize ART's impact and mitigate HIV's prevalence in SSA, stakeholders must consider these barriers, facilitators, and interventions when formulating policies or treatment modalities. For sustained positive ART outcomes, future research should target specific underrepresented groups like HIV-infected children, adolescents, and pregnant women in SSA to further delve into the barriers, facilitators and interventions promoting ART adherence.
Collapse
Affiliation(s)
- Amos Buh
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Raywat Deonandan
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - James Gomes
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Alison Krentel
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Olanrewaju Oladimeji
- Department of Public Health, Faculty of Health Sciences, Walter Sisulu University, Mthatha, Eastern Cape, South Africa
- Faculty of Health Sciences, Durban University of Technology, Durban, South Africa
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|
5
|
Jennings L, West RL, Halim N, Kaiser JL, Gwadz M, MacLeod WB, Gifford AL, Haberer JE, Orrell C, Sabin LL. Protocol for an evaluation of adherence monitoring and support interventions among people initiating antiretroviral therapy in Cape Town, South Africa-a multiphase optimization strategy (MOST) approach using a fractional factorial design. Trials 2023; 24:310. [PMID: 37147725 PMCID: PMC10163747 DOI: 10.1186/s13063-023-07322-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 04/21/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND South Africa bears a large HIV burden with 7.8 million people with HIV (PWH). However, due to suboptimal antiretroviral therapy (ART) adherence and retention in care, only 66% of PWH in South Africa are virally suppressed. Standard care only allows for suboptimal adherence detection when routine testing indicates unsuppressed virus. Several adherence interventions are known to improve HIV outcomes, yet few are implemented in routinely due to the resources required. Therefore, determining scalable evidence-based adherence support interventions for resource-limited settings (RLS) is a priority. The multiphase optimization strategy (MOST) framework allows for simultaneous evaluation of multiple intervention components and their interactions. We propose to use MOST to identify the intervention combination with the highest levels of efficacy and cost-effectiveness that is feasible and acceptable in primary care clinics in Cape Town. METHODS We will employ a fractional factorial design to identify the most promising intervention components for inclusion in a multi-component intervention package to be tested in a future randomized controlled trial. We will recruit 512 participants initiating ART between March 2022 and February 2024 in three Cape Town clinics and evaluate acceptability, feasibility, and cost-effectiveness of intervention combinations. Participants will be randomized to one of 16 conditions with different combinations of three adherence monitoring components: rapid outreach following (1) unsuppressed virus, (2) missed pharmacy refill collection, and/or (3) missed doses as detected by an electronic adherence monitoring device; and two adherence support components: (1) weekly check-in texts and (2) enhanced peer support. We will assess viral suppression (<50 copies/mL) at 24 months as the primary outcome; acceptability, feasibility, fidelity, and other implementation outcomes; and cost-effectiveness. We will use logistic regression models to estimate intervention effects with an intention-to-treat approach, employ descriptive statistics to assess implementation outcomes, and determine an optimal intervention package. DISCUSSION To our knowledge, ours will be the first study to use the MOST framework to determine the most effective combination of HIV adherence monitoring and support intervention components for implementation in clinics in a RLS. Our findings will provide direction for pragmatic, ongoing adherence support that will be key to ending the HIV epidemic. TRIAL REGISTRATION ClinicalTrials.gov NCT05040841. Registered on 10 September 2021.
Collapse
Affiliation(s)
- Lauren Jennings
- Desmond Tutu Health Foundation, Institute of Infectious Diseases and Molecular Medicine and the Department of Medicine, University of Cape Town, Cape Town, South Africa.
| | - Rebecca L West
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Nafisa Halim
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Jeanette L Kaiser
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Marya Gwadz
- Silver School of Social Work, New York University, New York, NY, USA
| | - William B MacLeod
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Allen L Gifford
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, 72 E Concord Street, Boston, MA, 02118, USA
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, 150 S. Huntington Ave, Boston, MA, 02130, USA
- Department of Health Policy and Management, Boston University School of Public Health, Talbot Building, T348W, Boston, MA, 02118, USA
| | - Jessica E Haberer
- Center for Global Health, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Catherine Orrell
- Desmond Tutu Health Foundation, Institute of Infectious Diseases and Molecular Medicine and the Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Lora L Sabin
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| |
Collapse
|
6
|
Meng X, Yin H, Ma W, Gu J, Lu Z, Fitzpatrick T, Zou H. Peer-Led Community-Based Support Services and HIV Treatment Outcomes Among People Living With HIV in Wuxi, China: Propensity Score-Matched Analysis of Surveillance Data From 2006 to 2021. JMIR Public Health Surveill 2023; 9:e43635. [PMID: 36961492 PMCID: PMC10131765 DOI: 10.2196/43635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 01/02/2023] [Accepted: 01/11/2023] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Community-based organizations deliver peer-led support services to people living with HIV. Systematic reviews have found that peer-led community-based support services can improve HIV treatment outcomes; however, few studies have been implemented to evaluate its impact on mortality using long-term follow-up data. OBJECTIVE We aimed to evaluate the associations between the receipt of peer-led community-based support services and HIV treatment outcomes and survival among people living with HIV in Wuxi, China. METHODS We performed a propensity score-matched retrospective cohort study using data collected from the Chinese National HIV/AIDS Comprehensive Information Management System for people living with HIV in Wuxi, China, between 2006 and 2021. People living with HIV who received adjunctive peer-led community-based support for at least 6 months from a local community-based organization (exposure group) were matched to people living with HIV who only received routine clinic-based HIV care (control group). We compared the differences in HIV treatment outcomes and survival between these 2 groups using Kaplan-Meier curves. We used competing risk and Cox proportional hazards models to assess correlates of AIDS-related mortality (ARM) and all-cause mortality. We reported adjusted subdistribution hazard ratio and adjusted hazard ratio with 95% CIs. RESULTS A total of 860 people living with HIV were included (430 in the exposure group and 430 in the control group). The exposure group was more likely to adhere to antiretroviral therapy (ART; 396/430, 92.1% vs 360/430, 83.7%; P<.001), remain retained in care 12 months after ART initiation (402/430, 93.5% vs 327/430, 76.1%; P<.001), and achieve viral suppression 9 to 24 months after ART initiation (357/381, 93.7% vs 217/243, 89.3%; P=.048) than the control group. The exposure group had significantly lower ARM (1.8 vs 7.0 per 1000 person-years; P=.01) and all-cause mortality (2.3 vs 9.3 per 1000 person-years; P=.002) and significantly higher cumulative survival rates (P=.003). The exposure group had a 72% reduction in ARM (adjusted subdistribution hazard ratio 0.28, 95% CI 0.09-0.95) and a 70% reduction in all-cause mortality (adjusted hazard ratio 0.30, 95% CI 0.11-0.82). The nonrandomized retrospective nature of our analysis prevents us from determining whether peer-led community-based support caused the observed differences in HIV treatment outcomes and survival between the exposure and control groups. CONCLUSIONS The receipt of peer-led community-based support services correlated with significantly improved HIV treatment outcomes and survival among people living with HIV in a middle-income country in Asia. The 15-year follow-up period in this study allowed us to identify associations with survival not previously reported in the literature. Future interventional trials are needed to confirm these findings.
Collapse
Affiliation(s)
- Xiaojun Meng
- Wuxi Municipal Center for Disease Control and Prevention, Wuxi, China
| | - Hanlu Yin
- Wuxi Municipal Center for Disease Control and Prevention, Wuxi, China
| | - Wenjuan Ma
- Wuxi Municipal Center for Disease Control and Prevention, Wuxi, China
| | - Jing Gu
- Wuxi Municipal Center for Disease Control and Prevention, Wuxi, China
| | - Zhen Lu
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Thomas Fitzpatrick
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, United States
| | - Huachun Zou
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
- Kirby Institute, University of New South Wales, Sydney, Australia
| |
Collapse
|
7
|
Lippman SA, de Kadt J, Ratlhagana MJ, Agnew E, Gilmore H, Sumitani J, Grignon J, Gutin SA, Shade SB, Gilvydis JM, Tumbo J, Barnhart S, Steward WT. Impact of short message service and peer navigation on linkage to care and antiretroviral therapy initiation in South Africa. AIDS 2023; 37:647-657. [PMID: 36468499 PMCID: PMC9994809 DOI: 10.1097/qad.0000000000003453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 11/18/2022] [Accepted: 11/25/2022] [Indexed: 12/07/2022]
Abstract
OBJECTIVE We examine the efficacy of short message service (SMS) and SMS with peer navigation (SMS + PN) in improving linkage to HIV care and initiation of antiretroviral therapy (ART). DESIGN I-Care was a cluster randomized trial conducted in primary care facilities in North West Province, South Africa. The primary study outcome was retention in HIV care; this analysis includes secondary outcomes: linkage to care and ART initiation. METHODS Eighteen primary care clinics were randomized to automated SMS ( n = 7), automated and tailored SMS + PN ( n = 7), or standard of care (SOC; n = 4). Recently HIV diagnosed adults ( n = 752) were recruited from October 2014 to April 2015. Those not previously linked to care ( n = 352) contributed data to this analysis. Data extracted from clinical records were used to assess the days that elapsed between diagnosis and linkage to care and ART initiation. Cox proportional hazards models and generalized estimating equations were employed to compare outcomes between trial arms, overall and stratified by sex and pregnancy status. RESULTS Overall, SMS ( n = 132) and SMS + PN ( n = 133) participants linked at 1.28 [95% confidence interval (CI): 1.01-1.61] and 1.60 (95% CI: 1.29-1.99) times the rate of SOC participants ( n = 87), respectively. SMS + PN significantly improved time to ART initiation among non-pregnant women (hazards ratio: 1.68; 95% CI: 1.25-2.25) and men (hazards ratio: 1.83; 95% CI: 1.03-3.26) as compared with SOC. CONCLUSION Results suggest SMS and peer navigation services significantly reduce time to linkage to HIV care in sub-Saharan Africa and that SMS + PN reduced time to ART initiation among men and non-pregnant women. Both should be considered candidates for integration into national programs. TRIAL REGISTRATION NCT02417233, registered 12 December 2014; closed to accrual 17 April 2015.
Collapse
Affiliation(s)
- Sheri A. Lippman
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Julia de Kadt
- International Training and Education Center for Health (I-TECH), Pretoria, Republic of South Africa
| | - Mary J. Ratlhagana
- International Training and Education Center for Health (I-TECH), Pretoria, Republic of South Africa
| | - Emily Agnew
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Hailey Gilmore
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Jeri Sumitani
- International Training and Education Center for Health (I-TECH), Pretoria, Republic of South Africa
| | - Jessica Grignon
- International Training and Education Center for Health (I-TECH), Pretoria, Republic of South Africa
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Sarah A. Gutin
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Starley B. Shade
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Jennifer M. Gilvydis
- International Training and Education Center for Health (I-TECH), Pretoria, Republic of South Africa
| | - John Tumbo
- Department of Family Medicine and Primary Health Care, Sefako Makgatho Health Sciences University, Pretoria, Republic of South Africa
| | - Scott Barnhart
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Wayne T. Steward
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| |
Collapse
|
8
|
Vander-Pallen R, Domfeh EA, Hayford FEA, Asante M, Amoah AGB, Asare GA, Wiredu EK. Nutritional status and effect of highly active anti-retroviral therapy (HAART) on selected trace elements in people living with HIV in Ghana. SCIENTIFIC AFRICAN 2023. [DOI: 10.1016/j.sciaf.2023.e01586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
|
9
|
Buchbinder SP, Siegler AJ, Coleman K, Vittinghoff E, Wilde G, Lockard A, Scott H, Anderson PL, Laborde N, van der Straten A, Christie RH, Marlborough M, Liu AY. Randomized Controlled Trial of Automated Directly Observed Therapy for Measurement and Support of PrEP Adherence Among Young Men Who have Sex with Men. AIDS Behav 2023; 27:719-732. [PMID: 35984607 PMCID: PMC9908647 DOI: 10.1007/s10461-022-03805-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2022] [Indexed: 11/26/2022]
Abstract
Measurement of adherence to oral pre-exposure prophylaxis (PrEP) in real-time has been challenging. We developed DOT Diary, a smartphone application that combines automated directly observed therapy with a PrEP adherence visualization toolkit, and tested its ability to measure PrEP adherence and to increase adherence among a diverse cohort of young men who have sex with men (MSM). We enrolled 100 MSM in San Francisco and Atlanta and randomly assigned them 2:1 to DOT Diary versus standard of care. Concordance between DOT Diary measurement and drug levels in dried blood spots was substantial, with 91.0% and 85.3% concordance between DOT Diary and emtricitabine-triphosphate and tenofovir-diphosphate, respectively. There was no significant difference in the proportion of participants with detectable PrEP drug levels at 24 weeks between study arms. These results suggest DOT Diary is substantially better than self-reported measures of adherence, but additional interventions are needed to improve PrEP adherence over time.
Collapse
Affiliation(s)
- Susan P Buchbinder
- Bridge HIV, San Francisco Department of Public Health, San Francisco, CA, USA.
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.
- Bridge HIV, San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 100, San Francisco, CA, 94102, USA.
| | - Aaron J Siegler
- Department of Epidemiology, Emory University, Atlanta, GA, USA
| | - Kenneth Coleman
- Bridge HIV, San Francisco Department of Public Health, San Francisco, CA, USA
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Gretchen Wilde
- Department of Epidemiology, Emory University, Atlanta, GA, USA
| | - Annie Lockard
- Department of Epidemiology, Emory University, Atlanta, GA, USA
| | - Hyman Scott
- Bridge HIV, San Francisco Department of Public Health, San Francisco, CA, USA
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | | | | | - Ariane van der Straten
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- ASTRA Consulting, Kensington, CA, USA
| | | | | | - Albert Y Liu
- Bridge HIV, San Francisco Department of Public Health, San Francisco, CA, USA
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| |
Collapse
|
10
|
Pascoe S, Fox M, Kane J, Mngadi S, Manganye P, Long LC, Metz K, Allen T, Sardana S, Greener R, Zheng A, Thea DM, Murray LK. Study protocol: A randomised trial of the effectiveness of the Common Elements Treatment Approach (CETA) for improving HIV treatment outcomes among women experiencing intimate partner violence in South Africa. BMJ Open 2022; 12:e065848. [PMID: 36549749 PMCID: PMC9772682 DOI: 10.1136/bmjopen-2022-065848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Intimate partner violence (IPV) is a barrier to consistent HIV treatment in South Africa. Previous trials have established that the Common Elements Treatment Approach (CETA), a cognitive-behavioural-based intervention, is effective in reducing mental and behavioural health problems but has not been trialled for effectiveness in improving HIV outcomes. This paper describes the protocol for a randomised trial that is testing the effectiveness of CETA in improving HIV treatment outcomes among women experiencing IPV in South Africa. METHODS AND ANALYSIS We are conducting a randomised trial among HIV-infected women on antiretroviral therapy, who have experienced sexual and/or physical IPV, to test the effect of CETA on increasing retention and viral suppression and reducing IPV. Women living with HIV who have an unsuppressed viral load or are at high risk for poor adherence and report experiencing recent IPV, defined as at least once within in the last 12 months, will be recruited from HIV clinics and randomised 1:1 to receive CETA or an active attention control (text message reminders). All participants will be followed for 24 months. Follow-up HIV data will be collected passively using routinely collected medical records. HIV outcomes will be assessed at 12 and 24 months post-baseline. Questionnaires on violence, substance use and mental health will be administered at baseline, post-CETA completion and at 12 months post-baseline. Our primary outcome is retention and viral suppression (<50 copies/mL) by 12 months post-baseline. We will include 400 women which will give us 80% power to detect an absolute 21% difference between arms. Our primary analysis will be an intention-to-treat comparison of intervention and control by risk differences with 95% CIs. ETHICS AND DISSEMINATION Ethics approval provided by University of the Witwatersrand Human Research Ethics Committee (Medical), Boston University Institutional Review Board and Johns Hopkins School Institutional Review Board. Results will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT04242992.
Collapse
Affiliation(s)
- Sophie Pascoe
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Matthew Fox
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Jeremy Kane
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Sithabile Mngadi
- Department of Internal Medicine, Faculty of Health Sciences University of the Witwatersrand, Johannesburg, South Africa
| | - Pertunia Manganye
- Department of Internal Medicine, Faculty of Health Sciences University of the Witwatersrand, Johannesburg, South Africa
| | - Lawrence C Long
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
- Boston University, Boston, Massachusetts, USA
| | - Kristina Metz
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Taylor Allen
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Srishti Sardana
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ross Greener
- Department of Internal Medicine, Faculty of Health Sciences University of the Witwatersrand, Johannesburg, South Africa
| | - Amy Zheng
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | | | - Laura K Murray
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| |
Collapse
|
11
|
Lahai M, Theobald S, Wurie HR, Lakoh S, Erah PO, Samai M, Raven J. Factors influencing adherence to antiretroviral therapy from the experience of people living with HIV and their healthcare providers in Sierra Leone: a qualitative study. BMC Health Serv Res 2022; 22:1327. [PMID: 36348488 PMCID: PMC9644013 DOI: 10.1186/s12913-022-08606-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 09/20/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Antiretroviral therapy (ART) is the primary mode of treatment for Human Immunodeficiency Virus (HIV). It slows disease progression and reduces the spread of infection. HIV treatment is also known to require a high level of adherence of over 90% to achieve good treatment outcomes and viral load suppression. In Sierra Leone, about 70% of People Living with HIV (PLHIV) are non-adherent in their first year of treatment. Understanding the reasons behind this high rate of non-adherence from the perspectives of both PLHIV and health workers is critical for developing strategies to improve adherence. This qualitative study is rooted in the field of public health services. It identifies the barriers and facilitators influencing adherence to antiretroviral treatment in Sierra Leone. METHODS: A qualitative study design using in-depth interviews of four healthcare workers and 16 PLHIV in two districts in Sierra Leone- Freetown and Bo. The interviews were analyzed using a grounded theory approach to identify emerging themes from the data. RESULTS The study identified several facilitators and barriers to ART adherence at the personal, community, and health system levels. The facilitators included perceived benefits of ART, family support, having an informal caregiver, receiving free ART medicines, and belonging to peer support groups. The identified barriers were stigma and discrimination, frequency of medication, use of traditional medicine, lack of money for food and transport, work barriers, inadequate medicines and test kits, limited health workers, and long distances to clinics. CONCLUSIONS Our study emphasized the need for implementing behavioural change communication programmes and activities to reduce stigma and discrimination in the community. Knowledge of the facilitators and barriers to antiretroviral therapy could provide relevant information for more responsive and equitable programmes supporting adherence implementation in low- and middle-income countries. This study also identifies the vital need for community integration of HIV treatment services.
Collapse
Affiliation(s)
- Michael Lahai
- grid.442296.f0000 0001 2290 9707Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, 00232 Sierra Leone
| | - Sally Theobald
- grid.48004.380000 0004 1936 9764Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Haja R. Wurie
- grid.442296.f0000 0001 2290 9707College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Sulaiman Lakoh
- grid.442296.f0000 0001 2290 9707College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Patrick O. Erah
- grid.413068.80000 0001 2218 219XFaculty of Pharmacy, University of Benin, Benin City, Nigeria
| | - Mohamed Samai
- grid.442296.f0000 0001 2290 9707College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Joanna Raven
- grid.48004.380000 0004 1936 9764Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| |
Collapse
|
12
|
Hossain F, Hasan M, Begum N, Mohan D, Verghis S, Jahan NK. Exploring the barriers to the antiretroviral therapy adherence among people living with HIV in Bangladesh: A qualitative approach. PLoS One 2022; 17:e0276575. [PMID: 36269716 PMCID: PMC9586390 DOI: 10.1371/journal.pone.0276575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 10/10/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Since the evolution of highly active antiretroviral therapy (ART), a near-perfect ART adherence level (>95%) is needed to control viral suppression. Non-adherence to treatment may lead to acquired immunodeficiency syndrome (AIDS) and drug resistance. Though the Bangladesh government provides free treatment and counselling services to people living with human immunodeficiency virus (PLHIV), only 22% of the identified PLHIV continue treatment. Therefore, this study aims to explore the barriers that obstruct the Bangladeshi PLHIV to ensure ART adherence. METHODS We conducted a qualitative study in Dhaka, Bangladesh, and recruited the sensitive study population following non-probability, mainly purposive sampling from a community-based registered organization for PLHIV. We conducted the in-depth interview using a semi-structured guideline with 15 consented respondents. We transcribed the audio-recorded interviews in the local language (Bangla) and then translated those into English for data analysis. During the data extraction process, the lead and corresponding authors independently extracted raw data to generate different themes and sub-themes and invited other authors to contribute when they could not solve any discrepancies. RESULTS The study identified three significant categories of barriers at the individual, community, and institutional levels that negatively interfered with ART adherence. The most dominant barriers were discrimination and rejection related to stigma, as almost all participants mentioned these barriers. Stigmatizing attitudes and the discriminatory act of the community people and healthcare providers critically affected their treatment adherence. Other leading barriers were improper inventory management of ART-related medicines and CD4 tests and lack of proper counselling. In addition, we found that a positive approach toward life and family support motivated some respondents to overcome the barriers. CONCLUSIONS We recommended strengthening Bangladesh's HIV/AIDS prevention, treatment, and management program with a special focus on the improvement of the supply chain of ART-related medicines and CD4 tests and ensuring proper counselling. In addition, we recommended strengthening the behaviour change communication and IEC activities at a large scale to destigmatize health facilities and community levels.
Collapse
Affiliation(s)
- Fariha Hossain
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Selangor Darul Ehsan, Malaysia
| | | | | | - Devi Mohan
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Selangor Darul Ehsan, Malaysia
| | - Sharuna Verghis
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Selangor Darul Ehsan, Malaysia
| | - Nowrozy Kamar Jahan
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Selangor Darul Ehsan, Malaysia
- * E-mail:
| |
Collapse
|
13
|
Garner BR, Burrus O, Ortiz A, Tueller SJ, Peinado S, Hedrick H, Harshbarger C, Galindo C, Courtenay-Quirk C, Lewis MA. A Longitudinal Mixed-Methods Examination of Positive Health Check: Implementation Results From a Type 1 Effectiveness-Implementation Hybrid Trial. J Acquir Immune Defic Syndr 2022; 91:47-57. [PMID: 35583962 PMCID: PMC9377502 DOI: 10.1097/qai.0000000000003018] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 04/25/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Positive Health Check is an evidence-based video doctor intervention developed for improving the medication adherence, retention in care, and viral load suppression of people with HIV receiving clinical care. SETTING Four HIV primary care clinics within the United States. METHODS As part of a type 1 hybrid trial, a mixed-methods approach was used to longitudinally assess the following 3 key implementation constructs over a 23-month period: innovation-values fit (ie, the extent to which staff perceive innovation use will foster the fulfillment of their values), organizational readiness for change (ie, the extent to which organizational members are psychologically and behaviorally prepared to implement organizational change), and implementation climate (ie, the extent to which implementation is expected, supported, and rewarded). Quantitative mixed-effects regression analyses were conducted to assess changes over time in these constructs. Qualitative analyses were integrated to help provide validation and understanding. RESULTS Innovation-values fit and organizational readiness for change were found to be high and relatively stable. However, significant curvilinear change over time was found for implementation climate. Based on the qualitative data, implementation climate declined toward the end of implementation because of decreased engagement from clinic champions and differences in priorities between research and clinic staff. CONCLUSIONS The Positive Health Check intervention was found to fit within HIV primary care service settings, but there were some logistical challenges that needed to be addressed. Additionally, even within the context of an effectiveness trial, significant and nonlinear change in implementation climate should be expected over time.
Collapse
Affiliation(s)
| | | | - Alexa Ortiz
- RTI International, Research Triangle Park, NC; and
| | | | | | | | - Camilla Harshbarger
- Centers for Disease Control and Prevention, Division of HIV Prevention, Atlanta, GA
| | - Carla Galindo
- Centers for Disease Control and Prevention, Division of HIV Prevention, Atlanta, GA
| | - Cari Courtenay-Quirk
- Centers for Disease Control and Prevention, Division of HIV Prevention, Atlanta, GA
| | | |
Collapse
|
14
|
Iribarren SJ, Milligan H, Chirico C, Goodwin K, Schnall R, Telles H, Iannizzotto A, Sanjurjo M, Lutz BR, Pike K, Rubinstein F, Rhodehamel M, Leon D, Keyes J, Demiris G. Patient-centered mobile tuberculosis treatment support tools (TB-TSTs) to improve treatment adherence: A pilot randomized controlled trial exploring feasibility, acceptability and refinement needs. LANCET REGIONAL HEALTH. AMERICAS 2022; 13:100291. [PMID: 36061038 PMCID: PMC9426680 DOI: 10.1016/j.lana.2022.100291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Background Digital adherence technologies hold promise to improve patient-centered tuberculosis (TB) monitoring, yet few studies have incorporated direct adherence monitoring or assessed patients' experiences with these technologies. We explored acceptability, feasibility, and refinement needs of the TB Treatment Support Tools (TB-TSTs) intervention linking a mobile app, a urine drug metabolite test, and interactive communication with a treatment supporter. Methods This pilot study was a parallel-designed single-center randomized controlled trial with exit interviews. Newly diagnosed TB patients were randomized 1:1 using a treatment allocation button in the REDCap software preloaded with a random allocation sequence to usual care or usual care plus the TB-TSTs intervention from a respiratory medicine hospital in the province of Buenos Aires, Argentina and followed for 6-months. Due to the nature of the intervention, blinding to the group allocation could not be achieved for the recruiter or patients. The treatment outcome data extractor was blinded to the group allocation of the participants. Intervention participants used the app to report self-administering medication, potential side effects, submit photos of the urine test, and interact with a treatment supporter. Outcomes were feasibility, acceptability, and treatment outcomes. Findings Forty-two patients were enrolled and evenly assigned to each group. Intervention participants submitted 147·2±58 (mean, SD) medication self-administration and 144·5±55 side effect reports out of 180 and 47.5±38·4 photos of the urine test out of 77. Treatment success for usual care was 81% [17/21] and 95% [20/21] for the TB-TSTs intervention. Thirty-three themes were identified within the main categories of motivation, what worked, issues experienced, and recommendations. Participants (n=12) rated it as 'easy to use' (4.57/5), 'would highly recommend to others' (4·43/5) and reported that access to the treatment support was a critical component. Recommendations included adding an alarm, appointment reminders, and off-line functionality. Interpretation Findings suggest that the TB-TSTs intervention was feasible and acceptable and further refinement and testing is warranted. Funding National Institute of Health K23NR017210.
Collapse
Affiliation(s)
- Sarah J Iribarren
- Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA, USA
| | - Hannah Milligan
- Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA, USA
| | - Cristina Chirico
- Tuberculosis Control Program of the 5 Health Region, Ministry of Health of the Province of Buenos Aires, Hospital Cetrángolo, Buenos Aires, Argentina
| | - Kyle Goodwin
- Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA, USA
| | - Rebecca Schnall
- Columbia University School of Nursing, New York City, NY, USA
| | - Hugo Telles
- Tuberculosis Control Program of the 5 Health Region, Ministry of Health of the Province of Buenos Aires, Hospital Cetrángolo, Buenos Aires, Argentina
| | - Alejandra Iannizzotto
- Tuberculosis Control Program of the 5 Health Region, Ministry of Health of the Province of Buenos Aires, Hospital Cetrángolo, Buenos Aires, Argentina
| | - Myrian Sanjurjo
- Hospital del Tórax Dr. Antonio A. Cetrángolo, Provincia de Buenos Aires, Argentina
| | - Barry R Lutz
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Kenneth Pike
- Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA, USA
| | - Fernando Rubinstein
- Institute of Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Marcus Rhodehamel
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Daniel Leon
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Jesse Keyes
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | | |
Collapse
|
15
|
Musinguzi P, Najjuma JN, Arishaba A, Ochen E, Ainembabazi R, Keizirege F, Sabano RL, Wakida EK, Obua C. Barriers and facilitators to the utilization of the intensive adherence counselling framework by healthcare providers in Uganda: a qualitative study. BMC Health Serv Res 2022; 22:1104. [PMID: 36045418 PMCID: PMC9429278 DOI: 10.1186/s12913-022-08495-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 08/29/2022] [Indexed: 11/29/2022] Open
Abstract
Background Uganda Ministry of Health (UMOH) embraced the World Health Organization recommendation for people living with human immunodeficiency virus with a detectable viral load (VL) exceeding 1000 copies/mL to receive intensive adherence counselling (IAC). The IAC framework was developed as a step-by-step guide for healthcare providers to systematically support persons with non-suppressed VL to develop a comprehensive plan for adhering to treatment. The objective of this study was to explore the current practice of the healthcare providers when providing IAC, and identify the barriers and facilitators to the utilization of the UMOH IAC framework at two health centers IV level in rural Uganda. Methods This was a descriptive cross-sectional qualitative study that explored the current practices of the healthcare providers when providing IAC, and identified the barriers and facilitators to the utilization of the UMOH IAC framework. We used an interview guide with unstructured questions about what the participants did to support the clients with non-suppressed VL, and semi-structured questions following a checklist of categories of barriers and facilitators that affect ‘providers of care’ as provided by the Supporting the Use of Research Evidence for policy in African health systems (SURE) framework. Current practice as well as the categories of barriers and facilitators formed the a priori themes which guided data collection and analysis. In this study we only included healthcare providers (i.e., medical doctors, clinical officer, nurses, and counsellors) as ‘providers of care’ excluding family members because we were interested in the health system. Results A total of 19 healthcare providers took part in the interviews. The healthcare providers reported lack of sufficient knowledge on the UMOH IAC framework; most of them did not receive prior training or sensitization when it was first introduced. They indicated that they lacked counselling and communication skills to effectively utilize the IAC framework, and they were not motivated to utilize it because of the high workload at the clinics compounded by the limited workforce. Conclusions Although the UMOH IAC framework is a good step-by-step guide for the healthcare providers, there is need to understand their context and assess readiness to embrace the new behavior before expecting spontaneous uptake and utilization. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08495-0.
Collapse
|
16
|
Loveday M, Furin J, Hlangu S, Naidoo T. "I am alive because of her": factors affecting adherence to combination antiretroviral therapy among people living with HIV in KwaZulu-Natal, South Africa. BMC Infect Dis 2022; 22:680. [PMID: 35941552 PMCID: PMC9361592 DOI: 10.1186/s12879-022-07667-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 07/30/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People living with HIV need to take lifelong, combination antiretroviral therapy (cART), but there have been only limited explorations of how factors affecting adherence can change over the course of an individual's lifetime. METHODS We carried out a qualitative study of men and women living with HIV in KwaZulu, Natal, South Africa who were prescribed cART and who had periods of higher and lower adherence. RESULTS 18 individuals participated in open-ended interviews. Using a dynamic theory of adherence, we identified factual, relational, and experiential factors that were associated with adherence and non-adherence to cART. Periods of non-adherence were commonly reported. Participants described relationships and experiences as being important influences on their ability to adhere to cART throughout their treatment journeys. CONCLUSIONS Periods of non-adherence to cART are common. While many cART counseling models are based on conveying facts to people prescribed cART, providing opportunities for supportive relationship where people can process their varied experiences is likely important to maintaining health for people living with HIV.
Collapse
Affiliation(s)
- Marian Loveday
- HIV Prevention Research Unit, South African Medical Research Council, Durban, KwaZulu-Natal, South Africa.,CAPRISA-MRC HIV-TB Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa
| | - Jennifer Furin
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Ave., Boston, MA, 02115, USA.
| | - Sindisiwe Hlangu
- HIV Prevention Research Unit, South African Medical Research Council, Durban, KwaZulu-Natal, South Africa
| | - Tasneem Naidoo
- R. K. Khan Hospital HAST Unit, Department of Health, Durban, KwaZulu-Natal, South Africa
| |
Collapse
|
17
|
Stewart J, Bukusi E, Sesay FA, Oware K, Donnell D, Soge OO, Celum C, Odoyo J, Kwena ZA, Scoville CW, Violette LR, Morrison S, Simoni J, McClelland RS, Barnabas R, Gandhi M, Baeten JM. Doxycycline post-exposure prophylaxis for prevention of sexually transmitted infections among Kenyan women using HIV pre-exposure prophylaxis: study protocol for an open-label randomized trial. Trials 2022; 23:495. [PMID: 35710444 PMCID: PMC9201793 DOI: 10.1186/s13063-022-06458-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 06/09/2022] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Women in Africa face disproportionate risk of human immunodeficiency virus (HIV) acquisition, accounting for more than half of new infections in Africa and similarly face a disproportionate burden of sexually transmitted infections (STIs). Very high STI prevalence is being observed globally, especially among people taking pre-exposure prophylaxis (PrEP) for HIV prevention. Doxycycline post-exposure prophylaxis (dPEP) has been proposed as an STI prevention strategy to reduce chlamydia, syphilis, and possibly gonorrhea, and trials are ongoing among cisgender men who have sex with men (MSM) and transgender women who are taking PrEP in high-income settings. We designed and describe here the first open-label trial to determine the effectiveness of dPEP to reduce STI incidence among cisgender women. METHODS We are conducting an open-label 1:1 randomized trial of dPEP versus standard of care (STI screening and treatment and risk-reduction counseling without dPEP) among 446 Kenyan women aged ≥ 18 and ≤ 30 years old women taking PrEP. Women are followed for 12 months, with quarterly STI testing, treatment, and adherence counseling. The primary trial outcome will be the combined incidence of Chlamydia trachomatis, Neisseria gonorrhoeae, and Treponema pallidum, compared between the randomized groups. We will also assess dPEP acceptability, tolerability, safety, impact on sexual behavior, adherence, and occurrence of antimicrobial resistance (AMR) in N. gonorrhoeae and C. trachomatis isolates. Finally, we will estimate cost per incident STI case and complications averted accounting for nonadherence and benefits relative AMR or side effects. DISCUSSION The results of this trial may have immediate implications for the global epidemic of STIs and sexual health. If effective, dPEP could put STI prevention into women's hands. While dPEP may be able to prevent STIs, it carries important risks that could counter its benefits; global debate about the balance of these potential risks and benefits requires data to inform policy and implementation and our study aims to fill this gap. TRIAL REGISTRATION ClinicalTrials.gov NCT04050540 .
Collapse
Affiliation(s)
- Jenell Stewart
- Department of Global Health, University of Washington, Box 359931, 325 Ninth Ave, WA 98104 Seattle, USA
- Department of Medicine (Infectious Diseases), University of Washington, Seattle, USA
| | - Elizabeth Bukusi
- Department of Global Health, University of Washington, Box 359931, 325 Ninth Ave, WA 98104 Seattle, USA
- Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Fredericka A. Sesay
- Department of Global Health, University of Washington, Box 359931, 325 Ninth Ave, WA 98104 Seattle, USA
- Department of Epidemiology, University of Washington, Seattle, USA
| | - Kevin Oware
- Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Deborah Donnell
- Department of Global Health, University of Washington, Box 359931, 325 Ninth Ave, WA 98104 Seattle, USA
- Department of Biostatistics, University of Washington, Seattle, USA
| | - Olusegun O. Soge
- Department of Global Health, University of Washington, Box 359931, 325 Ninth Ave, WA 98104 Seattle, USA
- Department of Medicine (Infectious Diseases), University of Washington, Seattle, USA
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, USA
| | - Connie Celum
- Department of Global Health, University of Washington, Box 359931, 325 Ninth Ave, WA 98104 Seattle, USA
- Department of Medicine (Infectious Diseases), University of Washington, Seattle, USA
- Department of Epidemiology, University of Washington, Seattle, USA
| | | | | | - Caitlin W. Scoville
- Department of Global Health, University of Washington, Box 359931, 325 Ninth Ave, WA 98104 Seattle, USA
| | - Lauren R. Violette
- Department of Medicine (Infectious Diseases), University of Washington, Seattle, USA
- Department of Epidemiology, University of Washington, Seattle, USA
| | - Susan Morrison
- Department of Global Health, University of Washington, Box 359931, 325 Ninth Ave, WA 98104 Seattle, USA
| | - Jane Simoni
- Department of Psychology, University of Washington, Seattle, USA
| | - R. Scott McClelland
- Department of Global Health, University of Washington, Box 359931, 325 Ninth Ave, WA 98104 Seattle, USA
- Department of Medicine (Infectious Diseases), University of Washington, Seattle, USA
- Department of Epidemiology, University of Washington, Seattle, USA
| | - Ruanne Barnabas
- Department of Global Health, University of Washington, Box 359931, 325 Ninth Ave, WA 98104 Seattle, USA
- Department of Medicine (Infectious Diseases), University of Washington, Seattle, USA
- Department of Epidemiology, University of Washington, Seattle, USA
| | - Monica Gandhi
- Department of Medicine, Division of HIV, Infectious Diseases, and Global Medicine, University of California San Francisco, San Francisco, USA
| | - Jared M. Baeten
- Department of Global Health, University of Washington, Box 359931, 325 Ninth Ave, WA 98104 Seattle, USA
- Department of Medicine (Infectious Diseases), University of Washington, Seattle, USA
- Department of Epidemiology, University of Washington, Seattle, USA
| |
Collapse
|
18
|
Adherence barriers and interventions to improve ART adherence in Sub-Saharan African countries: A systematic review protocol. PLoS One 2022; 17:e0269252. [PMID: 35704636 PMCID: PMC9200354 DOI: 10.1371/journal.pone.0269252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/17/2022] [Indexed: 12/02/2022] Open
Abstract
Background The HIV/AIDS pandemic continues to be a major public health concern, particularly in Sub-Saharan Africa (SSA). Despite efforts to reduce new infections and deaths with the use of antiretroviral therapy (ART), SSA countries continue to bear the heaviest burden of HIV/AIDS globally, accounting for two-thirds of global new infections. The goal of this review is to identify common barriers to ART adherence as well as common effective interventions that can be implemented across SSA countries to improve ART adherence. Methods A systematic review of published studies on adult HIV-positive patients aged 15 or above, that have assessed the barriers to ART adherence and interventions improving patients’ adherence to ART in SSA countries shall be conducted. We will conduct electronic searches for articles that have been published starting from January 2010 onwards. The databases that shall be searched will include Medline Ovid, CINAHL, Embase, and Scopus. The review will include experimental and quasi-experimental studies such as randomized and non-randomized controlled trials as well as comparative before and after studies, and observational studies—cross-sectional studies, cohort studies, prospective and retrospective studies. Two independent reviewers will screen all identified studies, extract data and appraise the methodological quality of the studies using standard critical appraisal tools from the Joanna Briggs Institute. The extracted data will be subjected to a meta-analysis and narrative synthesis. Discussion This review will synthesize existing evidence on ART adherence barriers and strategies for improving patient adherence to ART in SSA countries. It will identify common barriers to adherence and common interventions proven to improve adherence across SSA. We anticipate that the findings of this review will provide information policy makers and stakeholders involved in the fight against HIV, will find useful in deriving better ways of not only retaining patients on treatment but having them adhere to their treatment. Review registration This protocol has been registered with the International Prospective Register of Systematic Reviews (PROSPERO); registration number CRD42021262256.
Collapse
|
19
|
Erickson M, Shannon K, Ranville F, Magagula P, Braschel M, Ratzlaff A, Pick N, Kestler M, Deering K. Interpersonal violence and other social-structural barriers associated with needing HIV treatment support for women living with HIV. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP9926-NP9952. [PMID: 33403922 PMCID: PMC8507564 DOI: 10.1177/0886260520983257] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Women living with HIV (WLWH), experience disproportionate rates of violence, along with suboptimal HIV health outcomes, despite recent advancements in HIV treatment, known as antiretroviral therapy (ART). The objectives of this study were to: (a) describe different types of support needed to take ART and (b) investigate the social and structural correlates associated with needing support for ART adherence among WLWH. Data are drawn from Sexual health and HIV/AIDS: Women's Longitudinal Needs Assessment, a community-based open research cohort with cisgender and transgender WLWH, aged 14+ who live or access HIV services in Metro Vancouver, Canada (2014-present). Baseline and semi-annual questionnaires are administered by community interviewers alongside a clinical visit with a sexual health research nurse. Bivariate and multivariable logistic regression using generalized estimating equations and an exchangeable working correlation matrix was used to model factors associated with needing supports for ART adherence. Among 276 WLWH, 51% (n = 142) reported needing support for ART adherence; 95% of participants reported lifetime gender-based violence and identified many interpersonal, structural, community, and clinical supports that would facilitate and support ART adherence. In multivariable logistic regression, participants who were Indigenous (adjusted odds ratio [AOR]: 1.70, 95% confidence intervals [CI]: 1.07-2.72), or otherwise racialized (AOR: 2.36, 95% CI : 1.09-5.12) versus white, experienced recent gender-based physical violence (AOR : 1.54, 95% CI : 1.03-2.31), lifetime post-traumatic stress disorder (AOR : 1.97, 95% CI : 1.22-3.18), and recent illicit drug use (AOR : 2.15, 95% CI : 1.43-3.22), had increased odds of needing support for ART adherence. This research suggests a need for trauma-informed, culturally safe and culturally responsive practice and services for WLWH along the HIV care continuum to support ART adherence. All services should be developed by, with, and for WLWH and tailored according to gender identity, taking into account history, culture, and trauma, including the negative impacts of settler colonialism for Indigenous people.
Collapse
Affiliation(s)
| | - Kate Shannon
- Centre for Gender and Sexual Health Equity, Vancouver, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Flo Ranville
- Centre for Gender and Sexual Health Equity, Vancouver, Canada
| | | | | | - Andrea Ratzlaff
- Department of Family Medicine, Queens University, Kingston, Canada
| | - Neora Pick
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Oak Tree Clinic, British Columbia Women’s Hospital, Vancouver, Canada
| | - Mary Kestler
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Oak Tree Clinic, British Columbia Women’s Hospital, Vancouver, Canada
| | - Kathleen Deering
- Centre for Gender and Sexual Health Equity, Vancouver, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | | |
Collapse
|
20
|
Narváez M, Lins-Kusterer L, Valdelamar-Jiménez J, Brites C. Quality of Life and Antiretroviral Therapy Adherence: A Cross-Sectional Study in Colombia. AIDS Res Hum Retroviruses 2022; 38:660-669. [PMID: 35459414 DOI: 10.1089/aid.2021.0233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The introduction of highly active combined antiretroviral therapy (cART) has changed the management of HIV/AIDS, which is recognized as a chronic disease with relevant aspects, such as adherence and quality of life. This study aimed to compare clinical and demographic characteristics and health-related quality of life in people with adherence and non-adherence to cART. A cross-sectional study was carried out with 200 participants. The instruments used were the Adherence Follow-up Questionnaire, the Beck Depression Inventory-II, the 36-Item Short Form Health Survey and the WHOQOL-HIV BREF. Poisson regression was applied to obtain estimates of adjusted prevalence ratios (PRadj). Individuals lacking therapeutic support were more likely to be non-adherent than those with proper support (PR: 1.79). The health-related quality of life of individuals with non-adherence was 4% lower (PR = 0.96) in the general health domain than individuals with adherence. Non-adherence to cART was associated with lower quality of life in the general health domain and no therapeutic support.
Collapse
Affiliation(s)
- Mónica Narváez
- Post Graduation Program in Medicine and Health (PPgMS), Federal University of Bahia, Salvador, Brazil
- Research Laboratory in Infectious Diseases (LAPI), University Hospital Complex Professor Edgard Santos, Federal University of Bahia, Salvador, Brazil
| | - Liliane Lins-Kusterer
- Post Graduation Program in Medicine and Health (PPgMS), Federal University of Bahia, Salvador, Brazil
- Research Laboratory in Infectious Diseases (LAPI), University Hospital Complex Professor Edgard Santos, Federal University of Bahia, Salvador, Brazil
| | - Juliet Valdelamar-Jiménez
- Post Graduation Program in Medicine and Health (PPgMS), Federal University of Bahia, Salvador, Brazil
- Research Laboratory in Infectious Diseases (LAPI), University Hospital Complex Professor Edgard Santos, Federal University of Bahia, Salvador, Brazil
| | - Carlos Brites
- Post Graduation Program in Medicine and Health (PPgMS), Federal University of Bahia, Salvador, Brazil
- Research Laboratory in Infectious Diseases (LAPI), University Hospital Complex Professor Edgard Santos, Federal University of Bahia, Salvador, Brazil
| |
Collapse
|
21
|
Sabin LL, Gifford AL, Haberer JE, Harvey K, Sarkisova N, Martin K, West RL, Stephens J, Killian C, Halim N, Berkowitz N, Jennings K, Jennings L, Orrell C. Patients' and Providers' Views on Optimal Evidence-Based and Scalable Interventions for Individuals at High Risk of HIV Treatment Failure: Sequential Explorations Among Key Stakeholders in Cape Town, South Africa. AIDS Behav 2022; 26:2783-2797. [PMID: 35190943 DOI: 10.1007/s10461-022-03623-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2022] [Indexed: 11/25/2022]
Abstract
To support translation of evidence-based interventions into practice for HIV patients at high risk of treatment failure, we conducted qualitative research in Cape Town, South Africa. After local health officials vetted interventions as potentially scalable, we held 41 in-depth interviews with patients with elevated viral load or a 3-month treatment gap at community clinics, followed by focus group discussions (FGDs) with 20 providers (physicians/nurses, counselors, and community health care workers). Interviews queried treatment barriers, solutions, and specific intervention options, including motivational text messages, data-informed counseling, individual counseling, peer support groups, check-in texts, and treatment buddies. Based on patients' preferences, motivational texts and treatment buddies were removed from consideration in subsequent FGDs. Patients most preferred peer support groups and check-in texts while individual counseling garnered the broadest support among providers. Check-in texts, peer support groups, and data-informed counseling were also endorsed by provider sub-groups. These strategies warrant attention for scale-up in South Africa and other resource-constrained settings.
Collapse
Affiliation(s)
- Lora L Sabin
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown, 3rd Floor, Boston, MA, 02118, USA.
| | - Allen L Gifford
- Section of General Internal Medicine, Boston University School of Medicine and Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, 02118, USA
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, 02130, USA
| | - Jessica E Haberer
- Center of Global Health, Massachusetts General Hospital, Boston, MA, 02114, USA
- Department of Medicine, Harvard Medical School, Boston, MA, 02114, USA
| | - Kelsee Harvey
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown, 3rd Floor, Boston, MA, 02118, USA
| | - Natalya Sarkisova
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown, 3rd Floor, Boston, MA, 02118, USA
| | - Kyle Martin
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown, 3rd Floor, Boston, MA, 02118, USA
| | - Rebecca L West
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown, 3rd Floor, Boston, MA, 02118, USA
| | - Jessie Stephens
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown, 3rd Floor, Boston, MA, 02118, USA
| | - Clare Killian
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown, 3rd Floor, Boston, MA, 02118, USA
| | - Nafisa Halim
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown, 3rd Floor, Boston, MA, 02118, USA
| | | | - Karen Jennings
- City of Cape Town Health Department, Cape Town, South Africa
| | | | | |
Collapse
|
22
|
Sefah IA, Mensah F, Kurdi A, Godman B. Barriers and facilitators of adherence to antiretroviral treatment at a public health facility in Ghana: a mixed method study. Hosp Pract (1995) 2022; 50:110-117. [PMID: 35189065 DOI: 10.1080/21548331.2022.2045132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND HIV/AIDS is a disease of global public health concern with high morbidity and mortality rates. Poor adherence to antiretroviral therapy (ART) increases the risk of viral drug resistance and reduces treatment effectiveness towards viral suppression leading to disease progression, greater risk of death and increased risk of viral transmission. The study sought to assess current adherence levels to ART among patients in Ghana, exploring barriers and enablers of adherence to it, to provide future guidance to all key stakeholder groups. METHOD A mixed method approach was used comprising of a cross-sectional survey of patients followed by a focused group discussion with patients and an in-depth interview of four key health professionals working in the ART clinic of Atua Government Hospital, a primary care health facility in the Eastern Region of Ghana. A structured questionnaire was used to assess current adherence levels and their determinants among 231 randomly selected patients attending the clinic between July to September, 2019. Quantitative data were analysed using bivariate and multivariate methods while qualitative data were analysed using thematic framework approach. RESULTS Adherence levels was found to be 42.9% among our study population. Lower adherence to ART was associated with patients' belief in herbal medicine (aOR =0.34 CI: 0.19-0.61). Other barriers identified from the qualitative analysis included low motivation arising from pill fatigue, forgetfulness, frequent stock out of medicines, long waiting times and worrying side-effects; while enablers, on the other hand, included measures that ensure improved assessment of adherence and health facility-related activities that improve patient satisfaction with ART services. Conclusion: Adherence to ART among patients living with HIV was sub-optimal in our study population. Understanding of the barriers and factors that enable adherence to ART is a key step to developing evidence-based adherence improvement strategies to enhance clinical outcomes.
Collapse
Affiliation(s)
- Israel Abebrese Sefah
- Pharmacy Practice Department, School of Pharmacy, University of Health and Allied Sciences, Volta Region, Ghana
| | - Frederick Mensah
- Pharmacy Department, Atua Government Hospital, Eastern Region, Ghana
| | - Amanj Kurdi
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq.,Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, United Kingdom
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, United Kingdom.,School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria, 0208, South Africa.,Centre of Medical and Bio-allied Health Sciences Research, Ajman University, United Arab Emirates
| |
Collapse
|
23
|
Glasner S, Patrick K, Ybarra M, Reback CJ, Ang A, Kalichman S, Bachrach K, Garneau HC, Venegas A, Rawson RA. Promising outcomes from a cognitive behavioral therapy text-messaging intervention targeting drug use, antiretroviral therapy adherence, and HIV risk behaviors among adults living with HIV and substance use disorders. Drug Alcohol Depend 2022; 231:109229. [PMID: 34979421 DOI: 10.1016/j.drugalcdep.2021.109229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 11/08/2021] [Accepted: 11/11/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND To date, no studies have reported the use of text messaging to deliver cognitive behavioral therapy (CBT) to people living with HIV and substance use disorders. OBJECTIVE We developed and evaluated a 12-week, CBT-based text-messaging intervention (TXT-CBT) targeting drug use and adherence to antiretroviral therapy (ART) for adults with HIV and comorbid opioid and stimulant use disorders. MATERIALS AND METHODS Participants were randomly assigned to receive either TXT-CBT (n = 25) or an informational pamphlet (INFO) discussing substance use and medication adherence (n = 25). ART adherence, drug use, and HIV-risk behaviors were assessed at baseline, monthly during treatment, and treatment-end, and were compared between groups using a mixed-model repeated-measures analysis. Injection drug use was examined as a moderator of outcomes. RESULTS Relative to the INFO group, TXT-CBT participants evidenced increased ART adherence, measured by phone-based unannounced pill counts and biochemically by viral load and CD4 count. TXT-CBT participation was also associated with reductions in opioid use and HIV risk behaviors. While reductions in cocaine use were observed in the TXT-CBT group, relative to the INFO group, other stimulant use did not change. Among people who inject drugs, TXT-CBT produced increases in ART adherence and corresponding changes in viral load, relative to injection drug users in the control condition. CONCLUSIONS Findings demonstrated promising preliminary evidence for the efficacy of TXT-CBT in improving ART adherence and reducing drug use and HIV-risk behaviors among people with HIV infection and comorbid opioid and stimulant use disorders.
Collapse
Affiliation(s)
- Suzette Glasner
- UCLA Integrated Substance Abuse Programs, David Geffen School of Medicine, Los Angeles, USA; UCLA School of Nursing, Los Angeles, USA.
| | - Kevin Patrick
- University of California at San Diego, San Diego, USA
| | - Michele Ybarra
- Center for Innovative Public Health Research, San Clemente, USA
| | - Cathy J Reback
- UCLA Integrated Substance Abuse Programs, David Geffen School of Medicine, Los Angeles, USA; Friends Research Institute, West Hollywood, USA
| | - Alfonso Ang
- UCLA Integrated Substance Abuse Programs, David Geffen School of Medicine, Los Angeles, USA; UCLA School of Nursing, Los Angeles, USA
| | - Seth Kalichman
- University of Connecticut, Department of Psychology, Storrs, USA
| | | | - Hélène Chokron Garneau
- UCLA Integrated Substance Abuse Programs, David Geffen School of Medicine, Los Angeles, USA
| | - Alexandra Venegas
- UCLA Integrated Substance Abuse Programs, David Geffen School of Medicine, Los Angeles, USA
| | - Richard A Rawson
- UCLA Integrated Substance Abuse Programs, David Geffen School of Medicine, Los Angeles, USA; University of Vermont, Department of Psychiatry, Burlington, USA
| |
Collapse
|
24
|
Costa-Cordella S, Rossi A, Grasso-Cladera A, Duarte J, Cortes CP. Characteristics of psychosocial interventions to improve ART adherence in people living with HIV: A systematic review. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000956. [PMID: 36962602 PMCID: PMC10021974 DOI: 10.1371/journal.pgph.0000956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 09/20/2022] [Indexed: 12/27/2022]
Abstract
The HIV/AIDS pandemic continues to be a significant global public health crisis. The main HIV/AIDS treatment is the antiretroviral therapy (ART), which is highly effective but depends on the patient's adherence to be successful. However, the adherence to antiretroviral therapy remains unsatisfactory across different populations, which raises considerable difficulties at both individual and collective levels. Suboptimal adherence to ART can be overcome through multidisciplinary management that includes evidence-based psychosocial interventions. Existing reviews on these interventions have focused mainly on studies with experimental designs, overlooking valuable interventions whose evidence comes from different study designs. Here, we aimed to carry out a comprehensive review of the current research on psychosocial interventions for ART adherence and their characteristics including studies with different designs. We conducted a systematic review following PRISMA guidelines. We searched five databases (Pubmed, EBSCO, LILACS, WoS and SCIELO) for articles reporting a psychosocial intervention to improve treatment adherence for people living with HIV (adults). The quality of each study was analyzed with standardized tools, and data were summarized using a narrative synthesis method. Twenty-three articles were identified for inclusion, and they demonstrated good to fair quality. Individual counseling was the most frequent intervention, followed by SMS reminders, education, and group support. Most interventions combined different strategies and self-efficacy was the most common underlying theoretical framework. This review provides insight into the main characteristics of current psychosocial interventions designed to improve ART treatment adherence. PROSPERO number: CRD42021252449.
Collapse
Affiliation(s)
- Stefanella Costa-Cordella
- Centro de Estudios en Psicología Clínica y Psicoterapia (CEPPS), Facultad de Psicología, Universidad Diego Portales, Santiago, Chile
- Instituto Milenio Depresión y Personalidad (MIDAP), Santiago, Chile
| | - Alejandra Rossi
- Centro de Estudios en Neurociencia Humana y Neuropsicología (CENHN), Facultad de Psicología, Universidad Diego Portales, Santiago, Chile
| | - Aitana Grasso-Cladera
- Centro de Estudios en Psicología Clínica y Psicoterapia (CEPPS), Facultad de Psicología, Universidad Diego Portales, Santiago, Chile
- Centro de Estudios en Neurociencia Humana y Neuropsicología (CENHN), Facultad de Psicología, Universidad Diego Portales, Santiago, Chile
| | - Javiera Duarte
- Centro de Estudios en Psicología Clínica y Psicoterapia (CEPPS), Facultad de Psicología, Universidad Diego Portales, Santiago, Chile
- Instituto Milenio Depresión y Personalidad (MIDAP), Santiago, Chile
| | - Claudia P Cortes
- Hospital Clínico San Borja Arriarán & Fundación Arriarán, Santiago, Chile
- Medicine Departament, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| |
Collapse
|
25
|
Klein MB, Young J, Ortiz-Paredes D, Wang S, Walmsley S, Wong A, Martel-Laferrière V, Pick N, Conway B, Angel J, Baril JG, Fraser C, Lebouché B, Tan DHS, Sandre R, Trottier S, Peiris H, Jayaraman J, Singer J. Virological Outcomes After Switching to Abacavir/Lamivudine/Dolutegravir Combined with Adherence Support in People Living with HIV with Poor Adherence: A Phase IV, Multicentre Randomized Prospective Open Label Study (TriiADD-CTN 286). Patient Prefer Adherence 2022; 16:3267-3281. [PMID: 36536672 PMCID: PMC9759014 DOI: 10.2147/ppa.s379065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 10/12/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Many people living with HIV struggle to consistently adhere to antiretroviral therapy, fail to achieve long-term virologic control and remain at risk for HIV-related disease progression, development of resistance and may transmit HIV infection to others. OBJECTIVE To determine if switching from current multi-tablet (curART) to single-tablet antiretroviral therapy (abacavir/lamivudine/dolutegravir; ABC/3TC/DTG), both combined with individualized adherence support, would improve HIV suppression in non-adherent vulnerable populations. METHODS TriiADD was an investigator-initiated randomized, multicentre, open label study. HIV+ adults with documented non-adherence on curART were randomized in a 1:1 ratio to immediately switch to ABC/3TC/DTG or to continue curART. Both arms received adherence support. The primary outcome was the proportion of participants in each arm with HIV RNA < 50 copies/mL 24 weeks after randomization. RESULTS In total, 50 people were screened and 27 randomized from 11 sites across Canada before the trial was stopped early due to slow recruitment. Participants were predominantly from ethnocultural communities, Indigenous people and/or had a history of injection drug use. The proportion achieving HIV RNA < 50 copies/mL at week 24 was 4/12 (33%) in the curART arm vs 7/13 (54%) in the ABC/3TC/DTG arm; median Bayesian risk difference, 5% (95% CrI, -17 to 28%) higher for those randomized to ABC/3TC/DTG. We encountered difficulties with recruitment of participants without prior drug resistance, retention despite intensive support, reliably measuring adherence and in overcoming entrenched adherence barriers. CONCLUSION Results of our trial are consistent with a slight improvement in viral suppression in a vulnerable population when a single tablet regimen is combined with patient-level adherence support. Beyond treatment simplicity and tolerability, tailored interventions addressing stigma and social determinants of health are still needed. The numerous challenges we encountered illustrate how randomised trials may not be the best approach for assessing adherence interventions in vulnerable populations.
Collapse
Affiliation(s)
- Marina B Klein
- Division of Infectious Diseases and Chronic Viral Illness Service, Department of Medicine, McGill University Health Centre, Montreal, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada
- Canadian Institutes of Health Research, Canadian HIV Trials Network, Vancouver, Canada
- Correspondence: Marina B Klein, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, 1001 Decarie Boulevard, D02.4110, Montréal, H4A 3J1, Canada, Tel +1-514-843-2090, Fax +1-514-843-2092, Email
| | - Jim Young
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - David Ortiz-Paredes
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Shouao Wang
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Sharon Walmsley
- Canadian Institutes of Health Research, Canadian HIV Trials Network, Vancouver, Canada
- University Health Network, University of Toronto, Toronto, Canada
| | - Alexander Wong
- Department of Medicine, University of Saskatchewan, Regina, Canada
| | - Valérie Martel-Laferrière
- Department of Microbiology and Infectious Diseases, Centre de recherche du Centre hospitalier de l’Université de Montréal, Montreal, Canada
| | - Neora Pick
- Department of Medicine, Division of Infectious Diseases, University of British Columbia, Vancouver, Canada
| | - Brian Conway
- Vancouver Infectious Diseases Centre, Vancouver, Canada
| | | | - Jean-Guy Baril
- Clinique de Médecine Urbaine du Quartier Latin, Montreal, Canada
| | - Chris Fraser
- Cool Aid Community Health Centre, Victoria, Canada
| | - Bertrand Lebouché
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada
- Department of Family Medicine, McGill University, Montreal, Canada
| | - Darrell H S Tan
- Toronto General Hospital Research Institute, University Health Network, Toronto, Canada
| | - Roger Sandre
- HAVEN Program, Health Sciences North, Sudbury, Canada
| | - Sylvie Trottier
- Centre de Recherche du CHU de Québec, Department of Microbiology, Infectiology and Immunology, Université Laval, Quebec, Canada
| | - Hansi Peiris
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Jayamarx Jayaraman
- Canadian Institutes of Health Research, Canadian HIV Trials Network, Vancouver, Canada
| | - Joel Singer
- Canadian Institutes of Health Research, Canadian HIV Trials Network, Vancouver, Canada
| | | |
Collapse
|
26
|
Dibaba D, Kajela G, Chego M, Ermeko T, Zenbaba D, Hailu S, Kasim J, Abdulkadir A. Antiretroviral Treatment Adherence Level and Associated Factors Among Adult HIV-Positive Patients on Both HIV/AIDS Care Models: Comparative Study in Selected Hospitals of Western Ethiopia, 2019. HIV AIDS (Auckl) 2021; 13:1067-1078. [PMID: 34955657 PMCID: PMC8692783 DOI: 10.2147/hiv.s327784] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 11/13/2021] [Indexed: 12/19/2022] Open
Abstract
Background Many studies investigating antiretroviral treatment (ART) adherence found the majority of patients had suboptimal adherence for a variety of different reasons. The study aimed to compare the ART adherence level and associated factors among adult human immune deficiency virus (HIV) positive patients on both care models in selected hospitals. Methods An institution-based comparative cross-sectional study was conducted among 463 HIV positive patients on ART. The study samples were selected using systematic random sampling, and pretested semi-structured interviewer administered questionnaire was used to collect data. Binary and multivariable logistic regression analyses were used to see the association between outcome and predictors using odds ratio with a 95% confidence interval to estimate the strength of the association. Results The study had a response rate of 445 (96.1%). Of the study participants, 325 (73%) and 120 (27%) were from the routine and appointment spacing models, respectively. Patients on the appointment spacing model had higher levels of optimum adherence (87.5% vs 74.27%, respectively; p = 0.006). Patients’ satisfaction with health service delivery (OR = 0.31, 95%: CI 0.11–0.84), antiretroviral drug dosage taken per day (OR = 3, 95%: CI 1.16–8.1), disclosure of HIV status (OR = 0.30, 95%: CI 0.09–0.93), distance from patient residency to health facility (OR = 0.11, 95%: CI 0.03–0.34), the memory aids used (OR = 0.02, 95%: CI 0.01–0.05), and type of HIV/AIDS care model (OR= 0.24, 95%: CI 0.1–0.6) were factors significantly associated with ART adherence level. Conclusion ART patients on the appointment spacing model had higher optimum ART adherence levels than those on the routine schedule due to factors like satisfaction status, disclosure status, type of memory aid used, type of ART care model used, and distance from the care facility. Therefore, promoting adherence enablers and alleviating barriers of ART adherence will improve ART adherence levels.
Collapse
Affiliation(s)
- Diriba Dibaba
- Public Health Department, MaddaWalabu University Goba Referral Hospital, Goba, Oromia, Ethiopia
| | - Gemechu Kajela
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Oromia, Ethiopia
| | - Melese Chego
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Oromia, Ethiopia
| | - Tilahun Ermeko
- Public Health Department, MaddaWalabu University Goba Referral Hospital, Goba, Oromia, Ethiopia
| | - Demisu Zenbaba
- Public Health Department, MaddaWalabu University Goba Referral Hospital, Goba, Oromia, Ethiopia
| | - Sintayehu Hailu
- Public Health Department, MaddaWalabu University Goba Referral Hospital, Goba, Oromia, Ethiopia
| | - Jeylan Kasim
- Public Health Department, MaddaWalabu University Goba Referral Hospital, Goba, Oromia, Ethiopia
| | - Adem Abdulkadir
- Public Health Department, MaddaWalabu University Goba Referral Hospital, Goba, Oromia, Ethiopia
| |
Collapse
|
27
|
Ramsey SE, Ames EG, Uber J, Habib S, Clark S, Waldrop D. A Preliminary Test of an mHealth Facilitated Health Coaching Intervention to Improve Medication Adherence among Persons Living with HIV. AIDS Behav 2021; 25:3782-3797. [PMID: 34117965 PMCID: PMC8563378 DOI: 10.1007/s10461-021-03342-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2021] [Indexed: 11/24/2022]
Abstract
This study examined feasibility, acceptability, and preliminary efficacy of an mHealth facilitated health coaching antiretroviral therapy (ART) adherence intervention. Persons living with HIV (n = 53) were randomized to an in-person adherence session and 12 months of app access and health coaching via the app (Fitbit Plus) versus single adherence session (SOC). At baseline and 1, 3, 6, and 12 months, we measured ART adherence, substance use, and depressive symptoms. We also conducted individual qualitative interviews. The intervention was found to be largely feasible and highly acceptable, with the health coach spending an average of 2.4 min per month with a participant and 76.5% of Fitbit Plus participants using the app regularly at 12 months. While most comparisons were not significant, the pattern of results was consistent with better adherence in the Fitbit Plus compared to SOC condition. Substance use was significantly associated with poorer ART adherence while depressive symptoms were not.ClinicalTrials.gov Identifier: NCT02676128; Registered: 2/8/2016.
Collapse
Affiliation(s)
- Susan E Ramsey
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA.
- Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, RI, USA.
- Division of General Internal Medicine, Rhode Island Hospital, 593 Eddy Street, Providence, RI, 02903, USA.
| | - Evan G Ames
- Division of General Internal Medicine, Rhode Island Hospital, 593 Eddy Street, Providence, RI, 02903, USA
| | - Julia Uber
- Division of General Internal Medicine, Rhode Island Hospital, 593 Eddy Street, Providence, RI, 02903, USA
| | - Samia Habib
- Division of General Internal Medicine, Rhode Island Hospital, 593 Eddy Street, Providence, RI, 02903, USA
| | - Seth Clark
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA
- Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, RI, USA
- Division of General Internal Medicine, Rhode Island Hospital, 593 Eddy Street, Providence, RI, 02903, USA
| | - Drenna Waldrop
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| |
Collapse
|
28
|
Tunje A, Jerene D, Kristensson Hallström I. Antiretroviral Therapy and Retention in Care Experiences and Needs of Adolescents Living with HIV in Southern Ethiopia. HIV AIDS (Auckl) 2021; 13:999-1007. [PMID: 34858061 PMCID: PMC8631828 DOI: 10.2147/hiv.s339413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 11/12/2021] [Indexed: 11/23/2022] Open
Abstract
Background Adolescents with HIV are faced with challenges when taking care of their medication, which affects their treatment adherence. Therefore, this study aimed to explore the experiences and needs of adolescents living with HIV regarding their antiretroviral therapy adherence and retention in care in southern Ethiopia. Methods An inductive qualitative study design was applied to explore adolescents’ experiences and needs regarding antiretroviral treatment adherence and retention in care in southern Ethiopia. Eighteen adolescents were selected from five HIV care and treatment facilities by purposive sampling. The interviews followed an interview guide, translated into the participants’ national language. The interviews were transcribed verbatim and the first author developed a coding frame for the analysis by using NVivo software including meaning units and codes, which were discussed by all authors. Then, sub-themes and themes were identified and analyzed by qualitative content analysis. Results The results were described in two themes: barriers and facilitators for treatment adherence and retention in care. Barriers were described in seven subthemes and facilitators in three subthemes. Forgetting to take medication, hiding information, or non-disclosure of HIV status, being afraid to collect treatment drugs, being in an orphanage, and school activities were described as barriers while support from health care workers, families, personal motivation to cope with medication-related problems were described as facilitators for antiretroviral therapy adherence and retention in care. Conclusion Adherence is a major challenge among adolescents living with HIV in Ethiopia, with barriers that are unique to this age group and their living conditions. Therefore, interventions should be targeted to address privacy barriers, stigma, and lack of support.
Collapse
Affiliation(s)
- Abayneh Tunje
- Child and Family Health, Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
- School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
- Correspondence: Abayneh Tunje Tel +251920011972 Email
| | - Degu Jerene
- Child and Family Health, Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
- KNCV Tuberculosis Foundation, The Hague, Netherlands
| | | |
Collapse
|
29
|
Ajuna N, Tumusiime B, Amanya J, Awori S, Rukundo GZ, Asiimwe JB. Social Networks and Barriers to ART Adherence Among Young Adults (18-24 years) Living with HIV at Selected Primary Health Facilities of South-Western Uganda: A Qualitative Study. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2021; 13:939-958. [PMID: 34675686 PMCID: PMC8504700 DOI: 10.2147/hiv.s328643] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 09/23/2021] [Indexed: 11/23/2022]
Abstract
Background Young adults living with HIV (YALWH) struggle to maintain high levels of adherence to antiretroviral therapy (ART) because of numerous barriers. This study describes the social networks of YALWH (18–24 years), their barriers to ART adherence, and the perceived role of social networks in overcoming those barriers. Methods This study used a qualitative descriptive research design. Twenty-three (23) YALWH who were on ART for a period of greater than one (1) month and had consented to participate in the study were purposively selected from two primary health care facilities in southwestern Uganda. We held four (4) focus group discussions with the YALWH over 5 weeks between the 24th of July and 7th September 2020. Data were audio recorded, transcribed, and entered in Microsoft word 2010. Using the content analysis techniques, data were inductively coded and categories or themes developed. Results Most YALWH belonged to bonding (family, friends, and neighbors), followed by bridging (informal groups), and linking (health professionals) social networks, respectively. Most YALWH, irrespective of gender, had close connections with their mothers or elder sisters. The commonest form of bridging networks was informal community groups that provided financial services, whereas the linking ones comprised health professionals’ directly involved in HIV patient care such as nurses, counselors, and their affiliates (expert clients or clinic based peer supporters), who occasionally acted as bonding networks. Structural barriers to ART adherence (eg, stigma) were the most cited, followed by medication- (eg, pill burden), and patient-related barriers (eg, non-disclosure of HIV status). Bonding networks were perceived to help overcome patient, medication, and structural barriers to ART adherence. Bridging networks overcame structural and medication-related barriers to ART adherence. Linking networks were perceived to help overcome some health systems and medication-related barriers to ART adherence. Conclusion Bonding social networks seem to play a prominent role in overcoming numerous barriers to ART adherence compared with bridging and linking social networks.
Collapse
Affiliation(s)
- Noble Ajuna
- Department of Nursing, Bishop Stuart University, Mbarara City, Southwestern Uganda
| | - Brian Tumusiime
- Department of Nursing, Bishop Stuart University, Mbarara City, Southwestern Uganda
| | - Joseph Amanya
- Department of Nursing, Bishop Stuart University, Mbarara City, Southwestern Uganda
| | - Sharon Awori
- Department of Nursing, Bishop Stuart University, Mbarara City, Southwestern Uganda
| | - Godfrey Z Rukundo
- Department of Psychiatry, Mbarara University of Science and Technology, Mbarara City, Southwestern Uganda
| | - John Baptist Asiimwe
- Department of Nursing, Bishop Stuart University, Mbarara City, Southwestern Uganda
| |
Collapse
|
30
|
Bardon AR, Dorward J, Sookrajh Y, Sayed F, Quame-Amaglo J, Pillay C, Feutz E, Ngobese H, Simoni JM, Sharma M, Cressey TR, Gandhi M, Lessells R, Moodley P, Naicker N, Naidoo K, Thomas K, Celum C, Abdool Karim S, Garrett N, Drain PK. Simplifying TREAtment and Monitoring for HIV (STREAM HIV): protocol for a randomised controlled trial of point-of-care urine tenofovir and viral load testing to improve HIV outcomes. BMJ Open 2021; 11:e050116. [PMID: 34610939 PMCID: PMC8493905 DOI: 10.1136/bmjopen-2021-050116] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Substantial improvements in viral suppression among people living with HIV (PLHIV) are needed to end the HIV epidemic, requiring extensive scale-up of low-cost HIV monitoring services. Point-of-care (POC) tests for monitoring antiretroviral therapy (ART) adherence and viral load (VL) may be efficient and effective tools for real-time clinical decision making. We aim to evaluate the effects of a combined intervention of POC ART adherence and VL testing compared with standard-of-care on ART adherence, viral suppression and retention at 6 and 18 months post-ART initiation among PLHIV. METHODS AND ANALYSIS Simplifying TREAtment and Monitoring for HIV (STREAM HIV) is a two-arm, open-label, randomised controlled superiority trial of POC urine tenofovir (POC TFV) and VL monitoring in PLHIV. We aim to enrol 540 PLHIV initiating a first-line ART regimen at a public HIV clinic in South Africa. Participants will be randomised 1:1 to the intervention or control arm. Intervention arm participants will receive monthly POC TFV testing for the first 5 months and POC VL testing at months 6 and 12. Intervention arm participants will also receive reflex POC TFV testing if viraemic and reflex HIV drug resistance testing for those with viraemia and detectable TFV. Control arm participants will receive standard-of-care, including laboratory-based VL testing at months 6 and 12. Primary outcomes include ART adherence (TFV-diphosphate concentration) at 6 months and viral suppression and retention at 18 months. Secondary outcomes include viral suppression and retention at 6 months, TFV-diphosphate concentration at 18 months, cost and cost-effectiveness of the intervention and acceptability of the intervention among PLHIV and healthcare workers. ETHICS AND DISSEMINATION STREAM HIV has received ethical approval from the University of Washington Institutional Review Board (STUDY00007544), University of KwaZulu-Natal Biomedical Research Ethics Committee (BREC/00000833/2019) and Division of AIDS Regulatory Support Center (38509). Findings will be disseminated at international conferences and in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT04341779.
Collapse
Affiliation(s)
- Ashley R Bardon
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Jienchi Dorward
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Centre for the AIDS Programme of Research in South Africa, Durban, KwaZulu-Natal, South Africa
| | | | - Fathima Sayed
- Centre for the AIDS Programme of Research in South Africa, Durban, KwaZulu-Natal, South Africa
| | | | - Cheryl Pillay
- Centre for the AIDS Programme of Research in South Africa, Durban, KwaZulu-Natal, South Africa
| | - Erika Feutz
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Hope Ngobese
- eThekwini Municipality Health Unit, Durban, KwaZulu-Natal, South Africa
| | - Jane M Simoni
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Psychology, University of Washington, Seattle, Washington, USA
| | - Monisha Sharma
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Tim R Cressey
- Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - Monica Gandhi
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Richard Lessells
- Centre for the AIDS Programme of Research in South Africa, Durban, KwaZulu-Natal, South Africa
- Infectious Diseases Department, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
- KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Pravi Moodley
- National Health Laboratory Service, Durban, KwaZulu-Natal, South Africa
- Discipline of Virology, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Nivashnee Naicker
- Centre for the AIDS Programme of Research in South Africa, Durban, KwaZulu-Natal, South Africa
| | - Kogieleum Naidoo
- Centre for the AIDS Programme of Research in South Africa, Durban, KwaZulu-Natal, South Africa
- MRC HIV-TB Pathogenesis and Treatment Research Unit, Centre for the AIDS Programme of Research, Durban, KwaZulu-Natal, South Africa
- Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Katherine Thomas
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Connie Celum
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Salim Abdool Karim
- Centre for the AIDS Programme of Research in South Africa, Durban, KwaZulu-Natal, South Africa
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Nigel Garrett
- Centre for the AIDS Programme of Research in South Africa, Durban, KwaZulu-Natal, South Africa
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Paul K Drain
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
| |
Collapse
|
31
|
Packel L, Fahey C, Kalinjila A, Mnyippembe A, Njau P, McCoy SI. Preparing a financial incentive program to improve retention in HIV care and viral suppression for scale: using an implementation science framework to evaluate an mHealth system in Tanzania. Implement Sci Commun 2021; 2:109. [PMID: 34556176 PMCID: PMC8461932 DOI: 10.1186/s43058-021-00214-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 09/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Viral suppression is key to ending the HIV epidemic, yet only 58% of people living with HIV (PLHIV) in sub-Saharan Africa are suppressed. Cash transfers are an effective strategy to improve retention in care, but little is known about optimization of implementation; for example, designing effective programs that integrate into existing clinic workflows. We studied implementation of an mHealth system to deliver cash transfers to support retention. METHODS We conducted a mixed-methods study assessing implementation of an mHealth cash transfer study. This was part of a larger, hybrid implementation-effectiveness randomized controlled trial evaluating cash transfers conditional on visit attendance for viral suppression among Tanzanian PLHIV initiating ART. An mHealth system using fingerprint identification and mobile payments was used to automatically disburse mobile money to eligible PLHIV. We used Proctor's framework, assessing implementation of the mHealth system from the perspectives of PLHIV and clinicians. We analyzed mHealth system data and conducted surveys (n = 530) and in-depth interviews (n = 25) with PLHIV, clinic and pharmacy staff (n = 10), and structured clinic observations (n = 2293 visits). RESULTS One thousand six hundred fifty-one cash transfers were delivered to 346 PLHIV in the cash arms, 78% through mobile money. Among those in the cash arms, 81% registered their mobile money account with the mHealth system by study end, signaling high adoption. While acceptability for fingerprinting and mobile payments was high among PLHIV, interviews revealed mixed views: some had privacy concerns while others felt the system was secure and accurate, and provided some legitimacy to the clinical visits. Pharmacists praised system efficiency, but concerns about duplicative recordkeeping and added work arose. Clinic staff voiced excitement for the system's potential to bring the cash program to all patients and simplify workflows; yet concerns about multiple systems, staffing, and intermittent connectivity tempered enthusiasm, highlighting structural issues beyond program scope. Structured observations revealed a steep learning curve; repeat fingerprint scans and manual entry declined as the system improved. CONCLUSIONS Biometric identification and mobile payments were acceptable to most patients and staff. Fingerprinting encountered some feasibility limitations in the first months of testing; however, mobile payments were highly successful. Biometric identification and mobile payments may provide a scalable mechanism to improve patient tracking and efficiently implement financial incentives in low-resource settings. TRIAL REGISTRATION Name of the registry: clinicaltrials.gov Trial registration number: NCT03351556 Date of registration: 11/24/2017 Checklists: StaRI (included with submission). Note CONSORT for cluster-randomized trials was used for the main trial but is not directly applicable to this manuscript.
Collapse
Affiliation(s)
- Laura Packel
- School of Public Health, University of California Berkeley, Berkeley, CA, USA.
| | - Carolyn Fahey
- School of Public Health, University of California Berkeley, Berkeley, CA, USA
| | | | | | - Prosper Njau
- Health for a Prosperous Nation, Dar es Salaam, Tanzania.,National AIDS Control Programme, Ministry of Health, Community Development, Gender, Elderly, and Children, Dodoma, Tanzania
| | - Sandra I McCoy
- School of Public Health, University of California Berkeley, Berkeley, CA, USA
| |
Collapse
|
32
|
A Systematic Review of Nurse-Led Antiretroviral Medication Adherence Intervention Trials: How Nurses Have Advanced the Science. J Assoc Nurses AIDS Care 2021; 32:347-372. [PMID: 33883529 DOI: 10.1097/jnc.0000000000000247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Antiretroviral therapy (ART) is essential to achieving viral suppression and improving health and clinical outcomes in persons living with HIV. Despite the effectiveness of ART and many promising evidence-based ART adherence interventions, viral suppression rates continue to be less than optimal. Nurses play pivotal roles in HIV care management, yet their role in the development and delivery of evidence-based adherence interventions has received little attention. Therefore, this review examined the contributions of nurses to ART adherence research and delivery. We found that nurse-led and nurse-facilitated interventions can be effective in fostering ART adherence in persons living with HIV. Considering the role nurses play in HIV care management and the effectiveness of interventions involving nurses, more nurse-led and nurse-facilitated interventions to address ART adherence are indicated. However, there is a need for further research to examine multilevel interventions and comparative cost and effectiveness of nurse-delivered ART interventions with other forms of delivery.
Collapse
|
33
|
Modeling Adherence Interventions Among Youth with HIV in the United States: Clinical and Economic Projections. AIDS Behav 2021; 25:2973-2984. [PMID: 33547993 PMCID: PMC8342630 DOI: 10.1007/s10461-021-03169-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2021] [Indexed: 01/03/2023]
Abstract
The Adolescent Medicine Trials Network for HIV/AIDS Interventions is evaluating treatment adherence interventions (AI) to improve virologic suppression (VS) among youth with HIV (YWH). Using a microsimulation model, we compared two strategies: standard-of-care (SOC) and a hypothetical 12-month AI that increased cohort-level VS in YWH in care by an absolute ten percentage points and cost $100/month/person. Projected outcomes included primary HIV transmissions, deaths and life-expectancy, lifetime HIV-related costs, and incremental cost-effectiveness ratios (ICERs, $/quality-adjusted life-year [QALY]). Compared to SOC, AI would reduce HIV transmissions by 15% and deaths by 12% at 12 months. AI would improve discounted life expectancy/person by 8 months at an added lifetime cost/person of $5,300, resulting in an ICER of $7,900/QALY. AI would be cost-effective at $2,000/month/person or with efficacies as low as a 1 percentage point increase in VS. YWH-targeted adherence interventions with even modest efficacy could improve life expectancy, prevent onward HIV transmissions, and be cost-effective.
Collapse
|
34
|
King K, Horne R, Cooper V, Glendinning E, Michie S, Chalder T. The development of an intervention to support uptake and adherence to antiretroviral therapy in people living with HIV: the SUPA intervention. A brief report. Transl Behav Med 2021; 12:6348018. [PMID: 34379122 DOI: 10.1093/tbm/ibab104] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The effectiveness of antiretroviral therapy (ART) depends on prompt uptake of treatment and a high level of adherence over the long-term, yet these behaviors are suboptimal. Previous interventions have significantly improved adherence but effect sizes are generally small. The aim of this article is to describe the design and content of an intervention to support uptake and adherence to treatment in HIV positive patients (SUPA intervention), utilizing cognitive behavioral and motivational interviewing (MI) techniques. The intervention was developed in line with Medical Research Council (MRC) guidance for the development of complex interventions and informed by the NICE (National Institute for Health and Care Excellence) Guidelines for adherence, empirical evidence and focus groups. Behavior change techniques were mapped to perceptual and practical barriers to uptake and adherence to ART, identified in previous research. Intervention materials were designed and later discussed within focus groups, where feedback enabled an iterative process of development. We conclude it is possible to transparently report the design and content of a theory-based intervention to increase uptake and adherence to ART. The intervention has been evaluated within a randomized controlled trial (RCT) at 10 HIV clinics in England, the results of which will be reported elsewhere.
Collapse
Affiliation(s)
- Kathryn King
- Centre for Behavioural Medicine, UCL School of Pharmacy, London, United Kingdom
| | - Rob Horne
- Centre for Behavioural Medicine, UCL School of Pharmacy, London, United Kingdom
| | - Vanessa Cooper
- Centre for Behavioural Medicine, UCL School of Pharmacy, London, United Kingdom
| | | | - Susan Michie
- Centre for Behavioural Medicine, UCL School of Pharmacy, London, United Kingdom
| | - Trudie Chalder
- Psychological Medicine, King's College London, London, United Kingdom
| | | |
Collapse
|
35
|
Taiwo BO, Kuti KM, Kuhns LM, Omigbodun O, Awolude O, Adetunji A, Berzins B, Janulis P, Johnson AK, Okonkwor O, Oladeji BD, Muldoon A, Adewumi OM, Amoo P, Atunde H, Kapogiannis B, Garofalo R. Effect of Text Messaging Plus Peer Navigation on Viral Suppression Among Youth With HIV in the iCARE Nigeria Pilot Study. J Acquir Immune Defic Syndr 2021; 87:1086-1092. [PMID: 34153015 PMCID: PMC8496997 DOI: 10.1097/qai.0000000000002694] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 03/17/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Consistent with the global trend, youth with HIV (YWH) in Nigeria have high rates of viral nonsuppression. Hence, novel interventions are needed. SETTING Infectious Diseases Institute, College of Medicine, University of Ibadan, Nigeria. METHODS In a single-arm trial, participants aged 15-24 years received 48 weeks of a combination intervention, comprising daily 2-way text message medication reminders plus peer navigation. The primary outcome measure was viral suppression less than 200 copies/mL. The secondary outcome measures included self-reported adherence on a visual analog scale and medication possession ratio, each dichotomized as ≥90% (good) or <90% (poor) adherence. The outcomes were analyzed using McNemar test. Retention in care, intervention feasibility and acceptability, and participants' satisfaction were also assessed. RESULTS Forty YWH (50% male participants) were enrolled: mean age 19.9 years (SD = 2.5), 55% perinatally infected, and 35% virologically suppressed at baseline. Compared with baseline, the odds of virologic suppression was higher at 24 weeks (odds ratio = 14.00, P < 0.001) and 48 weeks (odds ratio = 6.00, P = 0.013). Self-reported adherence (≥90%) increased from baseline at 24 weeks (63%, P = 0.008) and 48 weeks (68%, P = 0.031). Medication possession ratio ≥90% increased at weeks 24 and 48 (85% and 80%, respectively), achieving statistical significance at 24 weeks alone (P = 0.022). Retention in care at 48 weeks was 87.5%. All (37/37) participants at week 48 were fully or mostly satisfied with the intervention. CONCLUSION Daily 2-way text message reminders plus peer navigation is a promising combination intervention to improve viral suppression among YWH in Nigeria.
Collapse
Affiliation(s)
- Babafemi O. Taiwo
- Division of Infectious Diseases and Center for Global Health, Northwestern University, Chicago, USA
| | - Kehinde M. Kuti
- Infectious Disease Institute, College of Medicine, University of Ibadan, Nigeria
| | - Lisa M. Kuhns
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, USA
- Division of Adolescent Medicine, Ann and Robert H Lurie Children’s Hospital of Chicago, USA
| | - Olayinka Omigbodun
- Department of Child and Adolescent Psychiatry, and Centre for Child and Adolescent Mental Health, College of Medicine, University of Ibadan, Nigeria
- Department of Psychiatry, College of Medicine, University of Ibadan, Nigeria
| | - Olutosin Awolude
- Infectious Disease Institute, College of Medicine, University of Ibadan, Nigeria
- Department of Obstetrics and Gynecology, and Infectious Disease Institute, College of Medicine, University of Ibadan, Nigeria
| | - Adedotun Adetunji
- Department of Family Medicine, University College Hospital, Ibadan, Nigeria
| | - Baiba Berzins
- Division of Infectious Diseases and Center for Global Health, Northwestern University, Chicago, USA
| | - Patrick Janulis
- Department of Medical Social Sciences, Northwestern University, Chicago, USA
| | - Amy K. Johnson
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, USA
- Division of Adolescent Medicine, Ann and Robert H Lurie Children’s Hospital of Chicago, USA
| | - Ogochukwu Okonkwor
- Division of Infectious Diseases and Center for Global Health, Northwestern University, Chicago, USA
| | - Bibilola D. Oladeji
- Department of Medical Social Sciences, Northwestern University, Chicago, USA
| | - Abigail Muldoon
- Division of Adolescent Medicine, Ann and Robert H Lurie Children’s Hospital of Chicago, USA
| | | | - Paul Amoo
- Infectious Disease Institute, College of Medicine, University of Ibadan, Nigeria
| | - Hannah Atunde
- Infectious Disease Institute, College of Medicine, University of Ibadan, Nigeria
| | - Bill Kapogiannis
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
| | - Robert Garofalo
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, USA
- Division of Adolescent Medicine, Ann and Robert H Lurie Children’s Hospital of Chicago, USA
| |
Collapse
|
36
|
Ahmed A, Abdulelah Dujaili J, Rehman IU, Lay Hong AC, Hashmi FK, Awaisu A, Chaiyakunapruk N. Effect of pharmacist care on clinical outcomes among people living with HIV/AIDS: A systematic review and meta-analysis. Res Social Adm Pharm 2021; 18:2962-2980. [PMID: 34353754 DOI: 10.1016/j.sapharm.2021.07.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 07/23/2021] [Accepted: 07/26/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Pharmacists play a significant role in the multidisciplinary care of people living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) (PLWHA). However, there is less evidence to clarify the impact of pharmacist as an individual team member on HIV care. OBJECTIVE This study aims to determine the effects of pharmacist intervention on improving adherence to antiretroviral therapy (ART), viral load (VL) suppression, and change in CD4-T lymphocytes in PLWHA. METHODS We identified relevant records from six databases (Pubmed, EMBASE, ProQuest, Scopus, Cochrane, and EBSCOhost) from inception till June 2020. We included studies that evaluated the impact of pharmacist care activities on clinical outcomes in PLWHA. A random-effect model was used to estimate the overall effect [odds ratio (OR) for dichotomous and mean difference (MD) for continuous data] with 95% confidence intervals (CIs). The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was used to evaluate the quality of evidence. The review protocol was published on PROSPERO (CRD42020167994). RESULTS Twenty-five studies involving 3206 PLWHA in which pharmacist-provided intervention either in the form of education with or without pharmaceutical-care either alone or as an interdisciplinary team member were included. Eight studies were randomized controlled trials (RCTs), while 17 studies were non-RCTs. Pooled-analyses showed a significant impact of pharmacist care compared to usual care group on adherence outcome (OR: 2.70 [95%, CI 1.80, 4.05]), VL suppression (OR: 4.13 [95% CI 2.27, 7.50]), and rise of CD4-T lymphocytes count (MD: 66.83 cells/mm3 [95% CI 44.08, 89.57]). The strength of evidence ranged from moderate, low to very low. CONCLUSION The findings suggest that pharmacist care improves adherence, VL suppression, and CD4-T lymphocyte improvement in PLWHA; however, it should be noted that the majority of the studies have a high risk of bias. More research with more rigorous designs is required to reaffirm the impact of pharmacist interventions on clinical and economic outcomes in PLWHA.
Collapse
Affiliation(s)
- Ali Ahmed
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway, 47500 Subang Jaya, Selangor, Malaysia.
| | - Juman Abdulelah Dujaili
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway, 47500 Subang Jaya, Selangor, Malaysia.
| | - Inayat Ur Rehman
- Department of Pharmacy, Abdul Wali Khan University Mardan, Pakistan.
| | - Alice Chuah Lay Hong
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway, 47500 Subang Jaya, Selangor, Malaysia.
| | - Furqan Khurshid Hashmi
- University College of Pharmacy, University of the Punjab, Allama Iqbal Campus, 54000, Lahore, Pakistan.
| | - Ahmed Awaisu
- College of Pharmacy, QU Health, Qatar University, P.O. Box 2713, Doha, Qatar.
| | - Nathorn Chaiyakunapruk
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway, 47500 Subang Jaya, Selangor, Malaysia; College of Pharmacy, University of Utah, Salt Lake City, UT, USA.
| |
Collapse
|
37
|
Uzoaru F, Nwaozuru U, Ong JJ, Obi F, Obiezu-Umeh C, Tucker JD, Shato T, Mason SL, Carter V, Manu S, BeLue R, Ezechi O, Iwelunmor J. Costs of implementing community-based intervention for HIV testing in sub-Saharan Africa: a systematic review. Implement Sci Commun 2021; 2:73. [PMID: 34225820 PMCID: PMC8259076 DOI: 10.1186/s43058-021-00177-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 06/22/2021] [Indexed: 12/20/2022] Open
Abstract
Background Community-based interventions (CBIs) are interventions aimed at improving the well-being of people in a community. CBIs for HIV testing seek to increase the availability of testing services to populations that have been identified as at high risk by reaching them in homes, schools, or community centers. However, evidence for a detailed cost analysis of these community-based interventions in sub-Saharan Africa (SSA) is limited. We conducted a systematic review of the cost analysis of HIV testing interventions in SSA. Methods Keyword search was conducted on SCOPUS, CINAHL, MEDLINE, PsycINFO, Web of Science, and Global Health databases. Three categories of key terms used were cost (implementation cost OR cost-effectiveness OR cost analysis OR cost-benefit OR marginal cost), intervention (HIV testing), and region (sub-Saharan Africa OR sub-Saharan Africa OR SSA). CBI studies were included if they primarily focused on HIV testing, was implemented in SSA, and used micro-costing or ingredients approach. Results We identified 1533 citations. After screening, ten studies were included in the review: five from East Africa and five from Southern Africa. Two studies conducted cost-effectiveness analysis, and one study was a cost-utility analysis. The remainder seven studies were cost analyses. Four intervention types were identified: HIV self-testing (HIVST), home-based, mobile, and Provider Initiated Testing and Counseling. Commonly costed resources included personnel (n = 9), materials and equipment (n = 6), and training (n = 5). Cost outcomes reported included total intervention cost (n = 9), cost per HIV test (n = 9), cost per diagnosis (n = 5), and cost per linkage to care (n = 3). Overall, interventions were implemented at a higher cost than controls, with the largest cost difference with HIVST compared to facility-based testing. Conclusion To better inform policy, there is an urgent need to evaluate the costs associated with implementing CBIs in SSA. It is important for cost reports to be detailed, uniform, and informed by economic evaluation guidelines. This approach minimizes biases that may lead decision-makers to underestimate the resources required to scale up, sustain, or reproduce successful interventions in other settings. In an evolving field of implementation research, this review contributes to current resources on implementation cost studies. Supplementary Information The online version contains supplementary material available at 10.1186/s43058-021-00177-y.
Collapse
Affiliation(s)
- Florida Uzoaru
- College of Public Health and Social Justice, Saint Louis University, St Louis, MO, USA.
| | - Ucheoma Nwaozuru
- College of Public Health and Social Justice, Saint Louis University, St Louis, MO, USA
| | - Jason J Ong
- Department of Clinical Research and Development, London School of Hygiene and Tropical Medicine, United Kingdom Central Clinical School, Monash University, Melbourne, Australia
| | - Felix Obi
- Health Policy Research Group, University of Nigeria, Nsukka, Nigeria
| | - Chisom Obiezu-Umeh
- College of Public Health and Social Justice, Saint Louis University, St Louis, MO, USA
| | - Joseph D Tucker
- Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Thembekile Shato
- College of Public Health and Social Justice, Saint Louis University, St Louis, MO, USA
| | - Stacey L Mason
- College of Public Health and Social Justice, Saint Louis University, St Louis, MO, USA
| | - Victoria Carter
- College of Public Health and Social Justice, Saint Louis University, St Louis, MO, USA
| | - Sunita Manu
- College of Public Health and Social Justice, Saint Louis University, St Louis, MO, USA
| | - Rhonda BeLue
- College of Public Health and Social Justice, Saint Louis University, St Louis, MO, USA
| | - Oliver Ezechi
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Juliet Iwelunmor
- College of Public Health and Social Justice, Saint Louis University, St Louis, MO, USA
| |
Collapse
|
38
|
Iversen J, Qureshi SUH, Zafar M, Busz M, Maher L. Adherence to antiretroviral therapy among HIV positive men who inject drugs in Pakistan. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 96:103281. [PMID: 34016509 DOI: 10.1016/j.drugpo.2021.103281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 04/13/2021] [Accepted: 04/21/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND People who inject drugs (PWID) living with HIV have poorer adherence to HIV antiretroviral therapy (ART) and elevated mortality compared to other populations. Little is known about factors associated with adherence among PWID in low-and middle-income countries, including in countries where opioid agonist therapy (OAT) is unavailable. We aimed to estimate ART adherence among men who inject drugs (MWID) living with HIV in Pakistan and identify factors independently associated with adherence. METHODS Nai Zindagi Trust (NZT) provides a range of HIV prevention, testing and treatment services to PWID in Pakistan. This study utilized data from HIV positive MWID who received ART refill/s from public sector ART Centres via NZT's Social Mobilizer Adherence Support Unit between September 2016 and December 2018. Multivariable logistic regression modelled factors independently associated with ART adherence. RESULTS Among 5,482 HIV positive MWID registered with NZT who had attended the AAU and were supplied with ART refills between September 2016 and December 2018., 55% were adherent to ART. Independent predictors of adherence were being married (AOR 1.38, 95% CI:1.23-1.55, p<0.001) and >5 years of education compared to those with no education (AOR 1.19, 95% CI:1.05-1.35, p = 0.005). MWID living on the street at night had lower adjusted odds of ART adherence (AOR 0.75, 95% CI:0.62-0.91, p = 0.003). CONCLUSIONS Findings indicate that MWID living with HIV continue to face barriers to ART adherence in Pakistan. Despite considerable evidence supporting the impact of OAT in increasing ART adherence among PWID, OAT remains illegal and inaccessible in Pakistan. Evidence-based interventions, including OAT, are needed to increase adherence and improve clinical outcomes, health equity and survival among PWID living with HIV in Pakistan.
Collapse
Affiliation(s)
- Jenny Iversen
- Viral Hepatitis Epidemiology and Prevention Program, The Kirby Institute, UNSW, Sydney, Australia.
| | | | | | | | - Lisa Maher
- Viral Hepatitis Epidemiology and Prevention Program, The Kirby Institute, UNSW, Sydney, Australia
| |
Collapse
|
39
|
Khan S, Spiegelman D, Walsh F, Mazibuko S, Pasipamire M, Chai B, Reis R, Mlambo K, Delva W, Khumalo G, Zwane M, Fleming Y, Mafara E, Hettema A, Lejeune C, Chao A, Bärnighausen T, Okello V. Early access to antiretroviral therapy versus standard of care among HIV-positive participants in Eswatini in the public health sector: the MaxART stepped-wedge randomized controlled trial. J Int AIDS Soc 2021; 23:e25610. [PMID: 32949103 PMCID: PMC7507004 DOI: 10.1002/jia2.25610] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 06/10/2020] [Accepted: 07/15/2020] [Indexed: 12/18/2022] Open
Abstract
Introduction The WHO recommends antiretroviral treatment (ART) for all HIV‐positive patients regardless of CD4 count or disease stage, referred to as “Early Access to ART for All” (EAAA). The health systems effects of EAAA implementation are unknown. This trial was implemented in a government‐managed public health system with the aim to examine the “real world” impact of EAAA on care retention and viral suppression. Methods In this stepped‐wedge randomized controlled trial, 14 public sector health facilities in Eswatini were paired and randomly assigned to stepwise transition from standard of care (SoC) to EAAA. ART‐naïve participants ≥18 years who were not pregnant or breastfeeding were eligible for enrolment. We used Cox proportional hazard models with censoring at clinic transition to estimate the effects of EAAA on retention in care and retention and viral suppression combined. Results Between September 2014 and August 2017, 3405 participants were enrolled. In SoC and EAAA respectively, 12‐month HIV care retention rates were 80% (95% CI: 77 to 83) and 86% (95% CI: 83 to 88). The 12‐month combined retention and viral suppression endpoint rates were 44% (95% CI: 40 to 48) under SoC compared to 80% (95% CI: 77 to 83) under EAAA. EAAA increased both retention (HR: 1·60, 95% CI: 1·15 to 2·21, p = 0.005) and retention and viral suppression combined (HR: 4.88, 95% CI: 2.96 to 8.05, p < 0.001). We also identified significant gaps in current health systems ability to provide viral load (VL) monitoring with 80% participants in SoC and 66% in EAAA having a missing VL at last contact. Conclusions The observed improvement in retention in care and on the combined retention and viral suppression provides an important co‐benefit of EAAA to HIV‐positive adults themselves, at least in the short term. Our results from this “real world” health systems trial strongly support EAAA for Eswatini and countries with similar HIV epidemics and health systems. VL monitoring needs to be scaled up for appropriate care management.
Collapse
Affiliation(s)
- Shaukat Khan
- Clinton Health Access Initiative (CHAI), Mbabane, Swaziland
| | - Donna Spiegelman
- Center on Methods for Implementation and Prevention Science and Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA.,Departments of Epidemiology, Biostatistics, Nutrition and Global Health, Harvard T.H Chan School of Public Health, Boston, MA, USA
| | - Fiona Walsh
- Clinton Health Access Initiative (CHAI), Boston, MA, USA
| | - Sikhatele Mazibuko
- Eswatini National ART program (SNAP), Ministry of Health, Mbabane, Swaziland
| | | | - Boyang Chai
- Department of Nutrition, Harvard T.H Chan School of Public Health, Boston, MA, USA
| | - Ria Reis
- Leiden University Medical Center, Leiden University, Leiden, the Netherlands.,Amsterdam Institute for Social Science, University of Amsterdam, Amsterdam, the Netherlands.,Children's Institute, University of Cape Town, Cape Town, South Africa
| | - Khudzie Mlambo
- Clinton Health Access Initiative (CHAI), Mbabane, Swaziland
| | - Wim Delva
- The South African Department of Science and Technology - National Research Foundation (DST-NRF) Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa.,Center for Statistics, Hasselt University, Diepenbeek, Belgium.,International Centre for Reproductive Health, Ghent University, Gent, Belgium.,KU Leuven, Rega Institute for Medical Research, Leuven, Belgium.,Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Gavin Khumalo
- Eswatini National Network of People Living with HIV (SWANNEPHA), Mbabane, Swaziland
| | | | | | - Emma Mafara
- Clinton Health Access Initiative (CHAI), Mbabane, Swaziland
| | - Anita Hettema
- Clinton Health Access Initiative (CHAI), Mbabane, Swaziland
| | | | - Ariel Chao
- Center on Methods for Implementation and Prevention Science and Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
| | - Till Bärnighausen
- Heidelberg Institute of Public Health, University of Heidelberg, Heidelberg, Germany.,Department of Global Health and Population, Harvard T.H Chan School of Public Health, Boston, MA, USA
| | - Velephi Okello
- Directorate Office, Ministry of Health, Mbabane, Swaziland
| |
Collapse
|
40
|
Olanrewaju AO, Sullivan BP, Bardon AR, Lo TJ, Cressey TR, Posner JD, Drain PK. Pilot evaluation of an enzymatic assay for rapid measurement of antiretroviral drug concentrations. Virol J 2021; 18:77. [PMID: 33858461 PMCID: PMC8048217 DOI: 10.1186/s12985-021-01543-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 04/03/2021] [Indexed: 01/16/2023] Open
Abstract
Objective Maintaining adequate drug adherence is crucial to ensure the HIV prevention benefits of pre-exposure prophylaxis (PrEP). We developed an enzymatic assay for rapidly measuring tenofovir-diphosphate (TFV-DP) concentrations—a metabolite that indicates long-term PrEP adherence. Setting The study was conducted at the Madison HIV Clinic at Harborview Medical Center in Seattle. Methods We enrolled adults receiving standard oral PrEP, and individuals not receiving any antiretrovirals. We measured TFV-DP concentrations in diluted whole blood using our novel REverSe TRanscrIptase Chain Termination (RESTRICT) assay, based on inhibition of HIV reverse transcriptase (RT) enzyme. Blood samples were diluted in water, DNA templates, nucleotides, RT, and intercalating dye added, and results measured with a fluorescence reader—stronger fluorescence indicated higher RT activity. We compared RESTRICT assay results to TFV-DP concentrations from matched dried blood spot samples measured by liquid chromatography tandem mass spectrometry (LC–MS/MS) using ≥ 700 fmol/punch TFV-DP as a threshold for adequate adherence (≥ 4 doses/week). Results Among 18 adults enrolled, 4 of 7 participants receiving PrEP had TFV-DP levels ≥ 700 fmol/punch by LC–MS/MS. RESTRICT fluorescence correlated with LC–MS/MS measurements (r = − 0.845, p < 0.0001). Median fluorescence was 93.3 (95% confidence interval [CI] 90.9 to 114) for samples < 700 fmol/punch and 54.4 (CI 38.0 to 72.0) for samples ≥ 700 fmol/punch. When calibrated to an a priori defined threshold of 82.7, RESTRICT distinguished both groups with 100% sensitivity and 92.9% specificity. Conclusions This novel enzymatic assay for measuring HIV reverse transcriptase activity may be suitable for distinguishing TFV-DP concentrations in blood that correspond to protective PrEP adherence.
Collapse
Affiliation(s)
| | - Benjamin P Sullivan
- Department of Mechanical Engineering, University of Washington, Seattle, USA
| | - Ashley R Bardon
- Department of Global Health, Schools of Medicine and Public Health, University of Washington, Seattle, USA
| | - Tiffany J Lo
- Department of Materials Science and Engineering, University of Washington, Seattle, USA
| | - Tim R Cressey
- PHPT/IRD 174, Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand.,Harvard T.H. Chan School of Public Health, Harvard University, Boston, USA.,Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - Jonathan D Posner
- Department of Mechanical Engineering, University of Washington, Seattle, USA.,Department of Chemical Engineering, University of Washington, Seattle, USA.,Department of Family Medicine, University of Washington, Seattle, USA
| | - Paul K Drain
- Department of Global Health, Schools of Medicine and Public Health, University of Washington, Seattle, USA. .,Department of Medicine, School of Medicine, University of Washington, Seattle, USA. .,Department of Epidemiology, School of Public Health, University of Washington, Seattle, USA.
| |
Collapse
|
41
|
Liu AY, Laborde ND, Coleman K, Vittinghoff E, Gonzalez R, Wilde G, Thorne AL, Ikeguchi E, Shafner L, Sunshine L, van der Straten A, Siegler AJ, Buchbinder S. DOT Diary: Developing a Novel Mobile App Using Artificial Intelligence and an Electronic Sexual Diary to Measure and Support PrEP Adherence Among Young Men Who Have Sex with Men. AIDS Behav 2021; 25:1001-1012. [PMID: 33044687 DOI: 10.1007/s10461-020-03054-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2020] [Indexed: 12/22/2022]
Abstract
Young men who have sex with men (YMSM) are highly vulnerable to HIV. While pre-exposure prophylaxis (PrEP) has demonstrated effectiveness, adherence has been low among YMSM and difficult to measure accurately. In collaboration with a healthcare company, we configured an automated directly-observed therapy (aDOT) platform for monitoring and supporting PrEP use. Based on interest expressed in focus groups among 54 YMSM, we combined aDOT with an electronic sexual diary to provide feedback on level of protection during sex and to motivate app use. In an 8-week optimization pilot with 20 YMSM in San Francisco and Atlanta, the app was found to be highly acceptable, with median System Usability Scale scores in the "excellent" range (80/100). App use was high, with median PrEP adherence of 91% based on aDOT-confirmed dosing. Most (84%) participants reported the app helped with taking PrEP. These promising findings support further evaluation of DOT Diary in future effectiveness studies.
Collapse
Affiliation(s)
- Albert Y Liu
- Bridge HIV, San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 100, San Francisco, CA, 94102, USA.
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
| | | | - Kenneth Coleman
- Bridge HIV, San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 100, San Francisco, CA, 94102, USA
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Rafael Gonzalez
- Bridge HIV, San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 100, San Francisco, CA, 94102, USA
| | - Gretchen Wilde
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Annie L Thorne
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | | | | | - Ariane van der Straten
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Women's Global Health Imperative, RTI International, San Francisco, CA, USA
| | - Aaron J Siegler
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Susan Buchbinder
- Bridge HIV, San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 100, San Francisco, CA, 94102, USA
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| |
Collapse
|
42
|
Vancampfort D, Byansi P, Ward PB, Mugisha J. Correlates of missed HIV appointments in low-resource settings: a study from Uganda. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2021; 20:125-131. [PMID: 33787457 DOI: 10.2989/16085906.2021.1895235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Aims: Alarming reports of antiretroviral treatment failure have recently emerged in sub-Saharan Africa. The onset of virologic failure has multiple causes but suboptimal treatment adherence is one of the leading causes. This study aimed to explore correlates of adherence to HIV appointments in community care patients living with HIV/AIDS in Uganda.Methods: Two hundred and ninety-five people living with HIV (median age 37.0 years; interquartile range 16.0; female 67.8% [n = 200]) reported whether they had missed any of their four-weekly appointments during the past 24 weeks. They also completed the Internalized AIDS-Related Stigma Scale, Generalized Anxiety Disorder-7, the Patient Health Questionnaire-9, the Alcohol-Use Disorders Identification Test, and the Physical Activity Vital Sign.Results: Thirty-three (11.2%) patients missed at least one of their six scheduled appointments in the 24-week period. The adjusted odds ratio for missing at least one of six appointments was 3.03 (95% CI: 1.21-8.43, p = 0.01) for those who were physically inactive, and 2.29 (95% CI: 0.93-5.63, p = 0.046) for those with depression.Conclusions: Targeting future rehabilitation studies for PLHIV around feelings of depression and around physical inactivity could be important in achieving optimal HIV treatment adherence.
Collapse
Affiliation(s)
- Davy Vancampfort
- KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium.,University Psychiatric Centre KU Leuven, Kortenberg, Belgium
| | - Peter Byansi
- Africa Social Development & Health Initiatives, Kampala, Uganda.,Faculty of Health Sciences, Uganda Martyrs University, Kampala, Uganda
| | - Philip B Ward
- University of New South Wales, Sydney, NSW, Australia.,Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia
| | - James Mugisha
- Department of Sociology and Social Administration, Kyambogo University, Kampala, Uganda.,Butabika National Referral and Mental Health Hospital, Kampala, Uganda
| |
Collapse
|
43
|
Bailey JV, Wayal S, Aicken CR, Webster R, Mercer CH, Nazareth I, Rait G, Peacock R, Murray E. Interactive digital interventions for prevention of sexually transmitted HIV. AIDS 2021; 35:643-653. [PMID: 33259345 PMCID: PMC7924981 DOI: 10.1097/qad.0000000000002780] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 03/11/2020] [Accepted: 03/13/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Digital technology offers good opportunities for HIV prevention. This systematic review assesses the effectiveness of interactive digital interventions (IDIs) for prevention of sexually transmitted HIV. METHODS We conducted a systematic search for randomized controlled trials (RCTs) of IDIs for HIV prevention, defining 'interactive' as producing personally tailored material. We searched databases including the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, PsycINFO, grey literature, reference lists, and contacted authors if needed.Two authors screened abstracts, applied eligibility and quality criteria and extracted data. Meta-analyses used random-effects models with standardized mean differences (SMD) for continuous outcomes and odds ratios (OR) for binary outcomes, assessing heterogeneity using the I2 statistic. RESULTS We included 31 RCTs of IDIs for HIV prevention. Meta-analyses of 29 RCTs comparing IDIs with minimal interventions (e.g. leaflet, waiting list) showed a moderate increase in knowledge (SMD 0.56, 95% CI 0.33 to 0.80), no effect on self-efficacy (SMD 0.13, 95% CI 0.00 to 0.27), a small improvement in intention (SMD 0.16, 95% CI 0.06 to 0.26), improvement in HIV prevention behaviours (OR 1.28, 95% CI 1.04 to 1.57) and a possible increase in viral load, but this finding is unreliable.We found no evidence of difference between IDIs and face-to-face interventions for knowledge, self-efficacy, intention, or HIV-related behaviours in meta-analyses of five small RCTs. We found no health economic studies. CONCLUSION There is good evidence that IDIs have positive effects on knowledge, intention and HIV prevention behaviours. IDIs are appropriate for HIV prevention in a variety of settings.Supplementary Video Abstract, http://links.lww.com/QAD/B934.
Collapse
Affiliation(s)
- Julia V. Bailey
- e-Health Unit, Research Department of Primary Care and Population Health, University College London
| | - Sonali Wayal
- e-Health Unit, Research Department of Primary Care and Population Health, University College London
- Development Media International
- Centre for Population Research in Sexual Health and HIV, Institute for Global Health, University College London, London
| | - Catherine R.H. Aicken
- Centre for Population Research in Sexual Health and HIV, Institute for Global Health, University College London, London
- School of Health Sciences, University of Brighton, Falmer, Brighton
| | - Rosie Webster
- e-Health Unit, Research Department of Primary Care and Population Health, University College London
| | - Catherine H. Mercer
- Centre for Population Research in Sexual Health and HIV, Institute for Global Health, University College London, London
| | - Irwin Nazareth
- Research Department of Primary Care and Population Health, University College London
| | - Greta Rait
- Research Department of Primary Care and Population Health, University College London
| | - Richard Peacock
- Whittington Health Library, The Whittington Hospital, London, UK
| | - Elizabeth Murray
- e-Health Unit, Research Department of Primary Care and Population Health, University College London
| |
Collapse
|
44
|
Interventions to Improve Adherence to Antiretroviral Therapy (ART) in Sub-Saharan Africa: An Updated Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052477. [PMID: 33802322 PMCID: PMC7967610 DOI: 10.3390/ijerph18052477] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 11/17/2022]
Abstract
Optimal adherence to antiretroviral therapy (ART) remains the bedrock of effective therapy and management of human immunodeficiency virus (HIV). This systematic review examines the effect of interventions in improving ART adherence in sub-Saharan Africa (SSA), which bears the largest global burden of HIV infection. In accordance with PRISMA guidelines, and based on our inclusion and exclusion criteria, PUBMED, MEDLINE, and Google Scholar databases were searched for published studies on ART adherence interventions from 2010 to 2019. Thirty-one eligible studies published between 2010 to 2019 were identified, the categories of interventions were structural, behavioral, biological, cognitive, and combination. Study characteristics varied across design, intervention type, intervention setting, country, and outcome measurements. Many of the studies were behavioral interventions conducted in hospitals with more studies being randomized controlled trial (RCT) interventions. Despite the study variations, twenty-four studies recorded improvements. Notwithstanding, more quality studies such as RCTs should be conducted, especially among key affected populations (KAPs) to control transmission of resistant strains of the virus. Reliable objective measures of adherence should replace the conventional subjective self-report. Furthermore, long-term interventions with longer duration should be considered when evaluating the effectiveness of interventions.
Collapse
|
45
|
Point-of-care and Near Real-time Testing for Antiretroviral Adherence Monitoring to HIV Treatment and Prevention. Curr HIV/AIDS Rep 2021; 17:487-498. [PMID: 32627120 DOI: 10.1007/s11904-020-00512-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE OF REVIEW In this report, we review the need for point-of-care (POC) or near real-time testing for antiretrovirals, progress in the field, evidence for guiding implementation of these tests globally, and future directions in objective antiretroviral therapy (ART) or pre-exposure prophylaxis (PrEP) adherence monitoring. RECENT FINDINGS Two cornerstones to end the HIV/AIDS pandemic are ART, which provides individual clinical benefits and eliminates forward transmission, and PrEP, which prevents HIV acquisition with high effectiveness. Maximizing the individual and public health benefits of these powerful biomedical tools requires high and sustained antiretroviral adherence. Routine monitoring of medication adherence in individuals receiving ART and PrEP may be an important component in interpreting outcomes and supporting optimal adherence. Existing practices and subjective metrics for adherence monitoring are often inaccurate or unreliable and, therefore, are generally ineffective for improving adherence. Laboratory measures of antiretroviral concentrations using liquid chromatography tandem mass spectrometry have been utilized in research settings to assess medication adherence, although these are too costly and resource-intensive for routine use. Newer, less costly technologies such as antibody-based methods can provide objective drug-level measurement and may allow for POC or near-patient adherence monitoring in clinical settings. When coupled with timely and targeted counseling, POC drug-level measures can support adherence clinic-based interventions to ART or PrEP in near real time.
Collapse
|
46
|
Ahonkhai AA, Pierce LJ, Mbugua S, Wasula B, Owino S, Nmoh A, Idigbe I, Ezechi O, Amaral S, David A, Okonkwo P, Dowshen N, Were MC. PEERNaija: A Gamified mHealth Behavioral Intervention to Improve Adherence to Antiretroviral Treatment Among Adolescents and Young Adults in Nigeria. FRONTIERS IN REPRODUCTIVE HEALTH 2021; 3. [PMID: 35237765 PMCID: PMC8887881 DOI: 10.3389/frph.2021.656507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: HIV is the leading cause of death for youth in Sub-Saharan Africa (SSA). The rapid proliferation of smart phones in SSA provides an opportunity to leverage novel approaches to promote adherence to life-saving antiretroviral therapy (ART) for adolescents and young adults living with HIV (AYA-HIV) that go beyond simple medication reminders. Methods: Guided by the Integrate, Design, Assess and Share (IDEAS) framework, our multidisciplinary team developed a peer-based mHealth ART adherence intervention—PEERNaija. Grounded in Social Cognitive Theory, and principles of contingency management and supportive accountability, PEERNaija delivers a multi-faceted behavioral intervention within a smartphone application to address important obstacles to adherence. Results:PEERNaija was developed as a gamified Android-based mHealth application to support the behavioral change goal of improving ART adherence among AYA-HIV within Nigeria, a low- and middle- income country (LMIC). Identified via foundational interviews with the target population and review of the literature, key individual (forgetfulness and poor executive functioning), environmental (poor social support) and structural (indirect cost of clinic-based interventions) barriers to ART adherence for AYA-HIV informed application features. Further informed by established behavioral theories and principles, the intervention aimed to improve self-efficacy and self-regulation of AYA-HIV, leverage peer relationships among AYA to incentivize medication adherence (via contingency management, social accountability), provide peer social support through an app-based chat group, and allow for outreach of the provider team through the incorporation of a provider application. Gamification mechanics incorporated within PEERNaija include: points, progress bar, leaderboard with levels, achievements, badges, avatars and targeted behavior change messages. PEERNaija was designed as a tethered mobile personal health record application, sharing data to the widely deployed OpenMRS electronic health record application. It also uses the secure opensource Nakama gamification platform, in line with Principles of Digital Development that emphasize use of opensource systems within LMICs. Conclusions: Theory-based gamified mHealth applications that incorporate social incentives have the potential to improve adherence to AYA-HIV. Ongoing evaluations of PEERNaija will provide important data for the potential role for a gamified, smartphones application to deliver multifaceted adherence interventions for vulnerable AYA-HIV in SSA.
Collapse
Affiliation(s)
- Aima A Ahonkhai
- Department of Medicine, Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, United States.,Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, United States.,Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Leslie J Pierce
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Samuel Mbugua
- Institute of Biomedical Informatics, Moi University, Kesses, Kenya
| | - Benjamin Wasula
- Institute of Biomedical Informatics, Moi University, Kesses, Kenya
| | - Samuel Owino
- Institute of Biomedical Informatics, Moi University, Kesses, Kenya
| | - Ashley Nmoh
- Department of Medicine Health and Society, Vanderbilt University, Nashville, TN, United States
| | - Ifeoma Idigbe
- Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Oliver Ezechi
- Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Sandra Amaral
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, United States
| | - Agatha David
- Nigerian Institute of Medical Research, Lagos, Nigeria
| | | | - Nadia Dowshen
- Craig-Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Martin C Were
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States.,Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
| |
Collapse
|
47
|
Kohli M, Pasipanodya EC, Montoya JL, Marquine M, Hoenigl M, Serrano V, Cushman C, Garcia R, Kua J, Gant V, Rojas S, Moore DJ. A Culturally Adapted SMS Text Messaging Intervention to Promote Antiretroviral Therapy Adherence Among African Americans: Protocol for a Single-Arm Trial. JMIR Res Protoc 2020; 9:e21592. [PMID: 33300885 PMCID: PMC7759437 DOI: 10.2196/21592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/18/2020] [Accepted: 09/22/2020] [Indexed: 12/02/2022] Open
Abstract
Background African Americans are disproportionally affected by HIV and have poorer rates of antiretroviral therapy (ART) adherence compared to other racial or ethnic groups in the United States. Factors associated with poor HIV disease outcomes are commonly associated with sociostructural barriers that prevent engagement with and retention in HIV care. SMS text messaging interventions to promote ART adherence among predominantly non-Hispanic White persons with HIV (PWH) have been shown to be efficacious; however, limited research has been devoted to culturally tailoring interventions for underrepresented racial/ethnic groups. Considering African Americans show poorer engagement along the HIV care continuum, we developed an individualized and culturally tailored two-way SMS text messaging intervention to improve ART adherence and associated virologic suppression among African American PWH. Objective In this paper we describe the protocol of a culturally tailored individualized Texting for Adherence Building (iTAB) intervention in a 24- to 48-week, single-arm study. Methods We developed a culturally tailored iTAB intervention, which we are implementing in a 24- to 48-week, single-arm study. Participants were recruited from the Family Health Centers of San Diego (FHCSD), a federally qualified health center. Patient inclusion criteria were (1) receiving care at the FHCSD, (2) living with HIV, (3) self-identification as Black, African American, or of African ancestry, (4) English speaking, (5) age 18 or older, (6) currently on ART, and (7) able to provide informed consent. Study enrollment began in November 2017 and closed in July 2019. A total of 90 participants from the FHCSD enrolled in the iTAB intervention, and we anticipate completing data collection in July 2020. Participants were assisted in individualizing and customizing their SMS text message preferences at the baseline study visit. Self-assessment measures are collected at baseline, interim, and final study visits. Problems related to sending/receiving SMS text messages and barriers to ART adherence are assessed at each interim study visit. The FHCSD staff monitors and tracks participants’ daily SMS text message responses to ART adherence reminders using a clinical dashboard. Results We hypothesize that the proportion of individuals achieving HIV virologic suppression (viral load <40 copies/mL) will be greater at the end of the intervention period compared to the proportion prior to study implementation. Additionally, we anticipate that rates of virologic suppression at the end of the intervention among participants receiving iTAB will be comparable to those among the general FHCSD non-African American population who did not receive iTAB. Finally, we anticipate a high response rate to iTAB SMS text messages as well as positive participant feedback at the end of the intervention with regard to the acceptability of, satisfaction with, and perceived efficacy of iTAB. Conclusions The iTAB intervention is a novel individualized two-way SMS text messaging intervention that has been culturally tailored for use among African Americans with HIV. We anticipate that iTAB will demonstrate efficacy in future randomized control trials and will be supportive of medication adherence among other populations facing health disparities. International Registered Report Identifier (IRRID) DERR1-10.2196/21592
Collapse
Affiliation(s)
- Maulika Kohli
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, United States.,San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, United States
| | - Elizabeth C Pasipanodya
- Rehabilitation Research Center, Santa Clara Valley Medical Center, San Jose, CA, United States
| | - Jessica L Montoya
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, United States.,University of California San Diego, San Diego, CA, United States
| | - Maria Marquine
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, United States.,University of California San Diego, San Diego, CA, United States
| | - Martin Hoenigl
- University of California San Diego, San Diego, CA, United States
| | - Vanessa Serrano
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, United States.,San Diego State University, San Diego, CA, United States
| | - Clint Cushman
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, United States.,University of California San Diego, San Diego, CA, United States
| | - Rogelio Garcia
- Family Health Centers of San Diego, San Diego, CA, United States
| | - John Kua
- Family Health Centers of San Diego, San Diego, CA, United States
| | - Verna Gant
- Family Health Centers of San Diego, San Diego, CA, United States
| | - Sarah Rojas
- San Diego State University, San Diego, CA, United States.,Family Health Centers of San Diego, San Diego, CA, United States
| | - David J Moore
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, United States.,University of California San Diego, San Diego, CA, United States
| |
Collapse
|
48
|
Quinn KG, Voisin DR. ART Adherence Among Men Who Have Sex with Men Living with HIV: Key Challenges and Opportunities. Curr HIV/AIDS Rep 2020; 17:290-300. [PMID: 32557117 DOI: 10.1007/s11904-020-00510-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW In the USA, gay, bisexual, and other men who have sex with men (MSM) are disproportionately affected by HIV. High levels of adherence to antiretroviral therapy (ART) can dramatically improve outcomes for persons living with HIV and reduce the risk of HIV transmission to others. Yet, there are numerous individual, social, and structural barriers to optimal ART adherence. Many of these factors disproportionately impact Black MSM and may contribute to their poorer rates of ART adherence. This review synthesizes the key challenges and intervention opportunities to improve ART adherence among MSM in the USA. RECENT FINDINGS Key challenges to ART adherence include stigma, violence, depression, and substance use. Black MSM are significantly disadvantaged by several of these factors. There are several promising interventions to improve ART adherence among MSM, and there remains an opportunity to culturally tailor these to the needs of Black MSM populations to enhance adherence. Despite high rates of HIV among MSM, there continues to be a paucity of research on the various contributors to poor ART adherence among this population. Similarly, few interventions have been tested that lead to increased and sustained ART adherence among Black MSM.
Collapse
Affiliation(s)
- Katherine G Quinn
- Center for AIDS Intervention Research (CAIR), Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, 2071 N. Summit, Milwaukee, WI, 53202, USA.
| | - Dexter R Voisin
- Factor-Intwentash School of Social Work, University of Toronto, Toronto, Canada
| |
Collapse
|
49
|
Packel L, Njau P, Fahey C, Ramadhani A, Dow WH, Jewell NP, McCoy S. Optimizing the efficiency and implementation of cash transfers to improve adherence to antiretroviral therapy: study protocol for a cluster randomized controlled trial. Trials 2020; 21:963. [PMID: 33228757 PMCID: PMC7684892 DOI: 10.1186/s13063-020-04899-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 11/12/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Antiretroviral therapy (ART) for HIV, taken daily, is an effective strategy to clinically suppress the virus, providing the dual benefit of improved survival and vastly decreasing the risk of transmission. However, this highly effective intervention has not yet reached all who could benefit. Cash transfers are increasingly recognized as an effective strategy to motivate behavior change and improve HIV care and treatment outcomes, including engagement in HIV care and adherence to ART. Despite a growing evidence base and strong theoretical foundation for the cash transfer approach, key questions remain. To address these questions and begin to bridge the "know-do gap" with respect to cash transfers, our team is employing an implementation science approach to iterative development of an incentive-based intervention to promote ART uptake and adherence among people living with HIV (PLHIV) in the Lake Zone region, Tanzania. METHODS We will conduct a type I hybrid implementation-effectiveness trial to test the effectiveness of a cash transfer intervention on the outcome of HIV viral suppression, and concurrently examine the potential for real-world implementation with a mobile health technology (mHealth) system. Specifically, our team will expand the intervention to 32 clinics and enroll 1984 PLHIV to (a) evaluate its effectiveness by conducting a cluster randomized controlled trial with clinics as the unit of randomization and 12-month viral suppression as the primary outcome and (b) evaluate the implementation challenges and successes at multiple levels (patient, provider, clinic). DISCUSSION This trial will provide evidence not only about the real-world effectiveness of cash transfers for retention in HIV care and viral suppression, but also on the implementation challenges and successes that will facilitate or hinder wider scale-up within Tanzania and beyond. TRIAL REGISTRATION ClinicalTrials.gov NCT04201353 . Registered on December 17, 2019.
Collapse
Affiliation(s)
- Laura Packel
- School of Public Health, Division of Epidemiology, University of California, Berkeley, 2121 Berkeley Way, 5th Floor, Berkeley, CA 94720 USA
| | - Prosper Njau
- Strategic Information and Research Unit, National AIDS Control Program (NACP), Ministry of Health, Community Development, Gender, Elderly, and Children, Dar es Salaam, Tanzania
| | - Carolyn Fahey
- School of Public Health, Division of Epidemiology, University of California, Berkeley, 2121 Berkeley Way, 5th Floor, Berkeley, CA 94720 USA
| | - Angela Ramadhani
- National AIDS Control Programme (NACP), Ministry of Health, Community Development, Gender, Elderly, and Children, Dar es Salaam, Tanzania
| | - William H. Dow
- School of Public Health, Division of Health Policy and Management, University of California, Berkeley, 2121 Berkeley Way, 5th Floor, Berkeley, CA 94720 USA
| | - Nicholas P. Jewell
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, Keppel Street, Bloomsbury, London, WC1E 7HT UK
- School of Public Health Biostatistics Division & Department of Statistics, University of California, Berkeley, 2121 Berkeley Way, 5th Floor, Berkeley, CA 94720 USA
| | - Sandra McCoy
- School of Public Health, Division of Epidemiology, University of California, Berkeley, 2121 Berkeley Way, 5th Floor, Berkeley, CA 94720 USA
| |
Collapse
|
50
|
Chatha ZF, Rashid U, Olsen S, Din FU, Khan A, Nawaz K, Gan SH, Khan GM. Pharmacist-led counselling intervention to improve antiretroviral drug adherence in Pakistan: a randomized controlled trial. BMC Infect Dis 2020; 20:874. [PMID: 33228562 PMCID: PMC7684945 DOI: 10.1186/s12879-020-05571-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 10/31/2020] [Indexed: 12/31/2022] Open
Abstract
Background Pakistan is facing a growing population of people living with human immunodeficiency (HIV). In this randomized controlled trial, we investigate if a pharmacist-led intervention can increase adherence to antiretroviral therapy (ART) for people living with HIV (PLWH). Methods Adults with HIV, who have been taking ART for more than 3 months were randomly assigned to receive either a pharmacist-led intervention or their usual care. Measures of adherence were collected at 1) baseline 2) just prior to delivery of intervention and 3) 8 weeks later. The primary outcomes were CD4 cell count and self-reported adherence measured with the AIDS Clinical Trial Group (ACTG) questionnaire. Results Post-intervention, the intervention group showed a statistically significant increase in CD4 cell counts as compared to the usual care group (p = 0.0054). In addition, adherence improved in the intervention group, with participants being 5.96 times more likely to report having not missed their medication for longer periods of time (p = 0.0086) while participants in the intervention group were 7.74 times more likely to report missing their ART less frequently (p < 0.0001). Conclusions The findings support the improvement in ART adherence and HIV management. Trial registration The trial is registered with Australian New Zealand Clinical Trials Registry (ACTRN12618001882213). Registered 20 November 2018. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-020-05571-w.
Collapse
Affiliation(s)
| | - Usman Rashid
- Health and Rehabilitation Research Institute, Auckland University of Technology (AUT), Auckland, New Zealand
| | - Sharon Olsen
- Health and Rehabilitation Research Institute, Auckland University of Technology (AUT), Auckland, New Zealand
| | - Fakhar Ud Din
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan.
| | - Amjad Khan
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan.
| | - Komal Nawaz
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
| | - Siew Hua Gan
- School of Pharmacy, Monash University Malaysia, 47500, Bandar Sunway, Selangor Darul Ehsan, Malaysia
| | - Gul Majid Khan
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan.
| |
Collapse
|