Incidence and predictors of attrition among patients receiving ART in eastern Zimbabwe before, and after the introduction of universal 'treat-all' policies: A competing risk analysis

Acceptability of a pilot motivational interviewing intervention at public health facilities to improve the HIV treatment cascade among people who inject drugs in Indonesia

BACKGROUND

HIV-positive people who inject drugs (PWID) experience challenges in initiating and adhering to antiretroviral treatment (ART). Counselling using motivational interviewing (MI) techniques may help them formulate individualised strategies, and execute actions to address these challenges collaboratively with their providers. We evaluated the acceptability of MI from a pilot implementation at three public health facilities in Indonesia.

METHODS

Adapting the acceptability constructs developed by Sekhon (2017) we assessed the acceptability to HIV-positive PWID clients (n = 12) and providers (n = 10) in four synthesised constructs: motivation (attributes that inspire engagement); cost consideration (sacrifices made to engage in MI); learned understanding (mechanism of action); and outcomes (ability to effect change with engagement). We included all providers and clients who completed ≥ 2 MI encounters. Qualitative analysis with an interpretive paradigm was used to extract and categorise themes by these constructs.

RESULTS

In motivation, clients valued the open communication style of MI, while providers appreciated its novelty in offering coherent structure with clear boundaries. In cost consideration, both groups faced a challenge in meeting MI encounters due to access or engagement in other health care areas. In learned understanding, clients understood that MI worked to identify problematic areas of life amenable to change to support long-term ART, with reconciliation in family life being the most targeted change. By contrast, providers preferred targeting tangible health outcomes to such behavioural proxies. In outcomes, clients were confident in their ability to develop behaviours to sustain ART uptakes, whereas providers doubted the outcome of MI on younger PWID or those with severe dependence.

CONCLUSIONS

There is broad acceptability of MI in motivating engagement for both actors. Relative to providers, clients were more acceptable in its mechanism and had greater confidence to perform behaviours conducive to ART engagement. Design innovations to improve the acceptability of MI for both actors are needed.

Attrition one year after starting antiretroviral therapy before and after the programmatic implementation of HIV "Treat All" in Sub-Saharan Africa: a systematic review and meta-analysis

INTRODUCTION

Evidence on the real-world effects of "Treat All" on attrition has not been systematically reviewed. We aimed to review existing literature to compare attrition 12 months after antiretroviral therapy (ART) initiation, before and after "Treat All" was implemented in Sub-Saharan Africa and describe predictors of attrition.

METHODS

We searched Embase, Google Scholar, PubMed, and Web of Science in July 2020 and created alerts up to the end of June 2023. We also searched for preprints and conference abstracts. Two co-authors screened and selected the articles. Risk of bias was assessed using the modified Newcastle-Ottawa Scale. We extracted and tabulated data on study characteristics, attrition 12 months after ART initiation, and predictors of attrition. We calculated a pooled risk ratio for attrition using random-effects meta-analysis.

RESULTS

Eight articles and one conference abstract (nine studies) out of 8179 screened records were included in the meta-analysis. The random-effects adjusted pooled risk ratio (RR) comparing attrition before and after "Treat All" 12 months after ART initiation was not significant [RR = 1.07 (95% Confidence interval (CI): 0.91-1.24)], with 92% heterogeneity (I2). Being a pregnant or breastfeeding woman, starting ART with advanced HIV, and starting ART within the same week were reported as risk factors for attrition both before and after "Treat All".

CONCLUSIONS

We found no significant difference in attrition before and after "Treat All" one year after ART initiation. While "Treat All" is being implemented widely, differentiated approaches to enhance retention should be prioritised for those subgroups at risk of attrition.

PROSPERO NUMBER

CRD42020191582 .

Attrition rate and its predictors among adults receiving anti-retroviral therapy following the implementation of the "Universal Test and Treat strategy" at public health institutions in Northern Ethiopia. A retrospective follow-up study

Introduction

Since 2016, the Ethiopian Federal Ministry of Health has adopted a "Universal Test and Treat" strategy to treat human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS). In this test and treat era, access to anti-retroviral therapy (ART) has been rapidly expanded. On the other hand, poor retention of patients on ART remains a serious concern for reaching ART program goals. Thus, this study is targeted at investigating the attrition rate and its predictors among HIV-positive adults following the implementation of the "test and treat" strategy in Ethiopia.

Methods

An institution-based retrospective follow-up study was conducted among 1048 HIV-positive adults receiving ART at public health institutions in Bahir Dar city, Northern Ethiopia. Data were extracted from randomly selected patient charts, entered into Epidata 4.6 and exported to Stata 14.2 for analysis. Kaplan-Meier curve was used to estimate individuals' attrition-free probability at each specific point in time. Both bivariable and multivariable cox regression models were fitted, and variables with a P-value of <0.05 in the multivariable model were considered as significant predictors of attrition.

Results

A total of 1020 (97.3%) study participants were included in the final analysis. The attrition rate of individuals was 15 per 100 person-years of observation (95% CI: 13.5-16.9 per 100 PYO). World Health organization (WHO) stage III/IV clinical diseases (Adjusted hazard ratio/AHR/1.75 (95% CI:1.24-2.48)), Not disclosing HIV-status (AHR 1.6 (95% CI: 1.24-2.05)), rapid initiation of ART (AHR 2.05 (95%CI:1.56-7.69)), No history of ART regime change (AHR2.03 (95% CI: 1.49-2.76)), "1J (TDF_3TC-DTG)" ART regimen (AHR 0.46 (95%CI: 2.18-3.65)), and Poor ART adherence (AHR2.82 (95%CI: 2.18-3.65)) were identified as significant predictors of attrition rate of HIV positive adults.

Conclusion

Following the implementation of the universal test and treat area, the attrition rate of adults living with (HIV) found to be high. Due attention shall be provided to those individuals who didn't disclose their status, were initiated into ART within seven days, had WHO stage III/IV clinical disease, had poor adherence history, had no regimen change, and are not on 1J (TDF_3TC-DTG) ART regimen type.