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Clemente T, Galli L, Lolatto R, Gagliardini R, Lagi F, Ferrara M, Cattelan AM, Focà E, Di Biagio A, Cervo A, Calza L, Maggiolo F, Marchetti G, Cenderello G, Rusconi S, Zazzi M, Santoro MM, Spagnuolo V, Castagna A. Cohort profile: PRESTIGIO, an Italian prospective registry-based cohort of people with HIV-1 resistant to reverse transcriptase, protease and integrase inhibitors. BMJ Open 2024; 14:e080606. [PMID: 38341206 PMCID: PMC10862296 DOI: 10.1136/bmjopen-2023-080606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 01/04/2024] [Indexed: 02/12/2024] Open
Abstract
PURPOSE The PRESTIGIO Registry was established in 2017 to collect clinical, virological and immunological monitoring data from people living with HIV (PLWH) with documented four-class drug resistance (4DR). Key research purposes include the evaluation of residual susceptibility to specific antiretrovirals and the validation of treatment and monitoring strategies in this population. PARTICIPANTS The PRESTIGIO Registry collects annual plasma and peripheral blood mononuclear cell samples and demographic, clinical, virological, treatment and laboratory data from PLWH followed at 39 Italian clinical centres and characterised by intermediate-to-high genotypic resistance to ≥1 nucleoside reverse transcriptase inhibitors, ≥1 non-nucleoside reverse transcriptase inhibitors, ≥1 protease inhibitors, plus either intermediate-to-high genotypic resistance to ≥1 integrase strand transfer inhibitors (INSTIs) or history of virological failure to an INSTI-containing regimen. To date, 229 people have been recorded in the cohort. Most of the data are collected from the date of the first evidence of 4DR (baseline), with some prebaseline information obtained retrospectively. Samples are collected from the date of enrollment in the registry. FINDINGS TO DATE The open-ended cohort has been used to assess (1) prognosis in terms of survival or development of AIDS-related or non-AIDS-related clinical events; (2) long-term efficacy and safety of different antiretroviral regimens and (3) virological and immunological factors predictive of clinical outcome and treatment efficacy, especially through analysis of plasma and cell samples. FUTURE PLANS The registry can provide new knowledge on how to implement an integrated approach to study PLWH with documented resistance to the four main antiretroviral classes, a population with a limited number of individuals characterised by a high degree of frailty and complexity in therapeutic management. Given the scheduled annual updates of PLWH data, the researchers who collaborate in the registry can send study proposals at any time to the steering committee of the registry, which evaluates every 3 months whether the research studies can be conducted on data and biosamples from the registry and whether they are aimed at a better understanding of a specific health condition, the emergence of comorbidities or the effect of potential treatments or experimental drugs that may have an impact on disease progression and quality of life. Finally, the research studies should aim to be inclusive, innovative and in touch with the communities and society as a whole. TRIAL REGISTRATION NUMBER NCT04098315.
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Affiliation(s)
- Tommaso Clemente
- Vita-Salute San Raffaele University, Milan, Italy
- Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Laura Galli
- Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Riccardo Lolatto
- Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Roberta Gagliardini
- National Institute for Infectious Diseases "L. Spallanzani" IRCCS, Rome, Italy
| | - Filippo Lagi
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Micol Ferrara
- Unit of Infectious Diseases, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Anna Maria Cattelan
- Infectious Diseases Unit, Department of Molecular Medicine, Padua University Hospital, Padua, Italy
| | - Emanuele Focà
- Unit of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, ASST Spedali di Brescia, Brescia, Italy
| | - Antonio Di Biagio
- Clinic of Infectious Diseases, IRCCS Policlinico San Martino Hospital, University of Genoa, Genoa, Italy
| | - Adriana Cervo
- Infectious Diseases Unit, Policlinico di Modena, Università Degli Studi di Modena e Reggio Emilia, Modena, Italy
| | - Leonardo Calza
- Unit of Infectious Diseases, Department of Medical and Surgical Sciences, S. Orsola Hospital, "Alma Mater Studiorum" University of Bologna, Bologna, Italy
| | - Franco Maggiolo
- Unit of HIV-related Diseases and Experimental Therapies, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Giulia Marchetti
- Clinic of Infectious Diseases, Department of Health Sciences, San Paolo Hospital, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | | | - Stefano Rusconi
- Infectious Diseases Unit, ASST Ovest Milanese, Legnano General Hospital, Legnano, Italy
- DIBIC, University of Milan, Milan, Italy
| | - Maurizio Zazzi
- Department of Medical Biotechnology, University of Siena, Siena, Italy
| | | | - Vincenzo Spagnuolo
- Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonella Castagna
- Vita-Salute San Raffaele University, Milan, Italy
- Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Mphande M, Robson I, Hubbard J, Chikuse E, Lungu E, Phiri K, Cornell M, Phiri S, Coates TJ, Dovel K. Developing a male-specific counselling curriculum for HIV treatment in Malawi. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.08.08.23293583. [PMID: 37609294 PMCID: PMC10441488 DOI: 10.1101/2023.08.08.23293583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
Men living with HIV in sub-Saharan Africa have sub-optimal engagement in antiretroviral therapy (ART) Programs. Generic ART counselling curriculum in Malawi does not meet men's needs and should be tailored to men. We developed a male-specific ART counselling curriculum, adapted from the Malawi Ministry of Health (MOH) curriculum based on literature review of men's needs and motivations for treatment. The curriculum was piloted through group counselling with men in 6 communities in Malawi, with focus group discussion (FGD) conducted immediately afterward (n=85 men) to assess knowledge of ART, motivators and barriers to care, and perceptions of the male-specific curriculum. Data were analysed in Atlas.ti using grounded theory. We conducted a half-day meeting with MOH and partner stakeholders to finalize the curriculum (n=5). The male-specific curriculum adapted three existing topics from generic counselling curriculum (status disclosure, treatment as prevention, and ART side effects) and added four new topics (how treatment contributes to men's goals, feeling healthy on treatment, navigating health systems, and self-compassion for the cyclical nature of lifelong treatment. Key motivators for men were embedded throughout the curriculum and included: family wellbeing, having additional children, financially stability, and earning/keeping respect. During the pilot, men reported having little understanding of how ART contributed to their personal goals prior to the male-specific counselling. Men were most interested in additional information about treatment as prevention, benefits of disclosure/social support beyond their sexual partner, how to navigate health systems, and side effects with new regimens. Respondents stated that the male-specific counselling challenged the idea that men were incapable of overcoming treatment barriers and lifelong medication. Male-specific ART counselling curriculum is needed to address men's specific needs. In Malawi context, topics should include: how treatment contributes to men's goals, navigating health systems, self-compassion/patience for lifelong treatment, and taking treatment while healthy.
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Stecher C, Ghai I, Lunkuse L, Wabukala P, Odiit M, Nakanwagi A, Linnemayr S. INcentives and ReMINDers to Improve Long-term Medication Adherence (INMIND): Protocol for a Pilot Randomized Controlled Trial in Uganda (Preprint). JMIR Res Protoc 2022; 11:e42216. [DOI: 10.2196/42216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 09/20/2022] [Accepted: 09/24/2022] [Indexed: 11/13/2022] Open
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Hill LM, Golin CE, Saidi F, Phanga T, Tseka J, Young A, Pearce LD, Maman S, Chi BH, Mutale W. Understanding PrEP decision making among pregnant women in Lilongwe, Malawi: A mixed-methods study. J Int AIDS Soc 2022; 25:e26007. [PMID: 36074034 PMCID: PMC9454413 DOI: 10.1002/jia2.26007] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 08/23/2022] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Pre-exposure prophylaxis (PrEP) is a promising tool for HIV prevention during pregnancy. With increasing rollout in antenatal settings, counselling strategies to help pregnant women make appropriate decisions about PrEP use are needed. Understanding women's motivations and concerns for PrEP use-and how these inform their decision making and feelings about the decision to start PrEP-are critical to inform these strategies. METHODS We conducted a convergent mixed-methods study from June 2020 to June 2021 in the context of a PrEP adherence support trial among HIV-negative pregnant women in Lilongwe, Malawi. Two hundred women completed a survey reporting their motivations and concerns about PrEP use, and their feelings about the decision to start PrEP (Decisional Regret Scale). Thirty women completed in-depth interviews to better understand the decision-making process, including motivations and concerns weighed in women's decision to use PrEP. Analyses comprised descriptive and bivariate statistics, thematic qualitative analysis, and integration of quantitative and qualitative results. RESULTS Women initiating PrEP during pregnancy were highly motivated to obtain HIV protection for themselves and their unborn child, often due to perceived HIV risk connoted by a recent sexually transmitted infection and/or concerns about partner non-monogamy. These motivations prevailed despite some concerns about safety and side effects, anticipated stigmatization, and concerns about adherence burden and pill attributes. Many women had informed their partner of their decision to use PrEP yet few felt their decision was contingent upon partner approval. Most women felt positively about the decision to start PrEP (mean decisional regret = 1.2 out of 5), but those with a greater number of concerns reported greater decisional regret (B = 0.036; p = 0.005). Furthermore, women who were specifically concerned about partner disclosure, who disliked pills or who had no perceived HIV risk reported greater decisional regret. CONCLUSIONS Pregnant women were strongly motivated by the promise of HIV protection offered by PrEP and accepted it despite diverse concerns. A shared decision-making approach that centres pregnant women and offers partner involvement may help identify and address initial concerns about PrEP use and support prevention-effective use of PrEP during this important period.
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Affiliation(s)
- Lauren M. Hill
- Department of Health BehaviorUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Carol E. Golin
- Department of Health BehaviorUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
- Department of MedicineUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Friday Saidi
- UNC Project‐MalawiLilongweMalawi
- Department of Obstetrics and GynecologySchool of MedicineUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | | | | | - Alinda Young
- Department of Maternal and Child HealthUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Lisa D. Pearce
- Department of SociologyUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Suzanne Maman
- Department of Health BehaviorUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Benjamin H. Chi
- Department of Obstetrics and GynecologySchool of MedicineUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Wilbroad Mutale
- Department of Health PolicyUniversity of Zambia School of Public HealthLusakaZambia
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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.
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Damtie Y, Kefale B, Yalew M, Arefaynie M, Adane B, Edmealem A, Andualem A. Depressive symptoms and associated factors among HIV positive patients attending public health facilities of Dessie town: A cross-sectional study. PLoS One 2021; 16:e0255824. [PMID: 34352017 PMCID: PMC8341501 DOI: 10.1371/journal.pone.0255824] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 07/23/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Depressive symptoms are the most common psychiatric complication of Human Immunodeficiency Virus (HIV) infection. They are associated with poor drug adherence, treatment failure, and increase the risk for suicide. There was limited evidence of depressive symptoms among HIV-positive patients in the study area. So, this study aimed to determine the prevalence of depressive symptoms and associated factors among HIV-positive patients attending public health facilities of Dessie town, North-central Ethiopia, 2019. METHOD A cross-sectional study was conducted on 380 HIV-positive patients attending ART clinics in Dessie town, North-central Ethiopia, 2019. Samples were selected using systematic random sampling and the data were collected by using structured, pretested, and interviewer-administered questionnaires. Patient Health Questionnaire (PHQ-9) at a cut-off point of 5 was used to assess depressive symptoms. The data were entered by Epi data version 3.1 and analyzed by SPSS version 25. A binary logistic regression model was used to identify factors associated with depressive symptoms. The Adjusted Odds Ratio (AOR) along with a 95% Confidence Interval (CI) was estimated to measure the association. The level of significance was declared at a p-value of less than 0.05. RESULT The prevalence of depressive symptoms among HIV positive patients was 15.5% (95% CI: (12.4%, 19.2%)). Age 40-49 years compared to 30-39 years (AOR = 2.96, 95% CI: (1.01, 8.68)), age ≥50 years compared to 30-39 years (AOR = 3.81, 95% CI: (1.05, 13.8)), having perceived stigma (AOR = 10.2, 95%CI: (4.26, 24.4)) taking medication other than Antiretroviral Therapy (ART) (AOR = 2.58, 95% CI: (1.25, 5.33)) and history of opportunistic infections (AOR = 5.17, 95% CI: (1.31, 20.4)) were factors associated with depressive symptoms. CONCLUSION The prevalence of depressive symptoms was low compared to previous studies. Age, perceived stigma, taking medication other than ART, and history of opportunistic infections were factors associated with depressive symptoms. Health education and counseling programs should be strengthened and target older patients, patients who took medications other than ART, patients who experienced perceived stigma and patients with a history of history opportunistic infections.
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Affiliation(s)
- Yitayish Damtie
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessi, Ethiopia
| | - Bereket Kefale
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessi, Ethiopia
| | - Melaku Yalew
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessi, Ethiopia
| | - Mastewal Arefaynie
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessi, Ethiopia
| | - Bezawit Adane
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessi, Ethiopia
| | - Afework Edmealem
- Department of Adult Health Nursing, School of Nursing and Midwifery, College of Medicine and Health Science, Wollo University, Dessi, Ethiopia
| | - Atsedemariam Andualem
- Department of Adult Health Nursing, School of Nursing and Midwifery, College of Medicine and Health Science, Wollo University, Dessi, Ethiopia
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McKinsey DS. Treatment and Prevention of Histoplasmosis in Adults Living with HIV. J Fungi (Basel) 2021; 7:jof7060429. [PMID: 34071599 PMCID: PMC8229061 DOI: 10.3390/jof7060429] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 05/22/2021] [Accepted: 05/25/2021] [Indexed: 11/16/2022] Open
Abstract
Histoplasmosis causes life-threatening disseminated infection in adult patients living with untreated HIV. Although disease incidence has declined dramatically in countries with access to antiretroviral therapy, histoplasmosis remains prevalent in many resource-limited regions. A high index of suspicion for histoplasmosis should be maintained in the setting of a febrile multisystem illness in severely immunosuppressed patients, particularly in persons with hemophagocytic lymphohistiocytosis. Preferred treatment regimens for initial therapy include liposomal amphotericin B for severe disease, or itraconazole for mild to moderate disease. Subsequently, itraconazole maintenance therapy should be administered for at least one year and then discontinued if CD4 count increases to ≥150 cells/µL. Antiretroviral therapy, which improves outcome when administered together with an antifungal agent, should be instituted immediately, as the risk of triggering Immune Reconstitution Syndrome is low. The major risk factor for relapsed infection is nonadherence. Itraconazole prophylaxis reduces risk for histoplasmosis in patients with CD4 counts <100/µL but is not associated with survival benefit and is primarily reserved for use in outbreaks. Although most patients with histoplasmosis have not had recognized high-risk exposures, avoidance of contact with bird or bat guano or inhalation of aerosolized soil in endemic regions may reduce risk. Adherence to effective antiretroviral therapy is the most important strategy for reducing the incidence of life-threatening histoplasmosis.
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Affiliation(s)
- David S McKinsey
- Metro Infectious Disease Consultants, Kansas City, MO 64132, USA
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Enriquez M, Cheng AL, McKinsey D, Farnan R, Ortego G, Hayes D, Miles L, Reese M, Downes A, Enriquez A, Akright J, El Atrouni W. Peers Keep It Real: Re-engaging Adults in HIV Care. J Int Assoc Provid AIDS Care 2020; 18:2325958219838858. [PMID: 30950300 PMCID: PMC6748541 DOI: 10.1177/2325958219838858] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background: After diagnosis, a substantial number of people with HIV disease fall out of care.
Effective interventions are needed for this priority population. Methods: The “Peers Keep It Real” study aimed to help adults who were disengaged from HIV
treatment. Peers, lay individuals living with HIV, facilitated intervention sessions.
Participants were randomized to immediately receive the peer-facilitated intervention or
were wait-listed. Results: Considerable attrition occurred in the control group. Pre-/postanalyses showed that
among participants (n = 23) who received the intervention, 65% had viral load
suppression and 100% remained in care at 12 months postintervention. Impact on viral
load was significant (P = .0326), suggesting that peers are effective
change agents who positively impacted outcomes for individuals struggling with adherence
to HIV treatment. Conclusion: Future endeavors should consider providing all individuals from this priority
population with an active peer intervention from the onset to enhance retention and
adherence.
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Affiliation(s)
- Maithe Enriquez
- 1 Sinclair School of Nursing, University of Missouri, Columbia, MO, USA
| | - An-Lin Cheng
- 2 School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| | - David McKinsey
- 3 Metro Infectious Disease Consultants, Kansas City, MO, USA
| | - Rose Farnan
- 4 Truman Medical Center-Hospital Hill, Kansas City, MO, USA
| | - Gerry Ortego
- 4 Truman Medical Center-Hospital Hill, Kansas City, MO, USA
| | - Deana Hayes
- 4 Truman Medical Center-Hospital Hill, Kansas City, MO, USA
| | | | | | | | | | - Jan Akright
- 1 Sinclair School of Nursing, University of Missouri, Columbia, MO, USA
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Determinants of Hepatitis C Treatment Adherence and Treatment Completion Among Veterans in the Direct Acting Antiviral Era. Dig Dis Sci 2019; 64:3001-3012. [PMID: 30903364 DOI: 10.1007/s10620-019-05590-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Accepted: 03/12/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Despite the availability of direct acting antiviral medications (DAAs), there are ongoing concerns about adherence to hepatitis C virus (HCV) treatment. We sought to understand the barriers to and facilitators of DAA adherence in the Veteran population. METHODS Patients completed semi-structured interviews focused on barriers to and facilitators of HCV treatment adherence both pre- and post-DAA treatment. Adherence was assessed via provider pill count and self-report. Thematic analyses were conducted in the qualitative software program Atlas.ti in order to understand anticipated barriers to and facilitators of treatment adherence and completion. Charts were reviewed for clinical data and sustained virologic response (SVR12). RESULTS Of 40 patients, 15 had cirrhosis and 10 had prior interferon-based treatment. Pre-treatment interviews revealed anticipated barriers to adherence such as side effects (n = 21) and forgetting pills (n = 11). Most patients (n = 27) reported following provider advice, and others had unique reasons not to (e.g., feeling like a "guinea pig"). Post-treatment interviews uncovered facilitators of treatment including wanting to cure HCV (n = 17), positive results (n = 18), and minimal side effects (n = 15). Three patients (8%) did not complete therapy (whom we further elaborate on) and 6 (15%) missed doses but completed treatment. SVR12 was achieved by all participants who completed therapy (93%). Patients who did not complete therapy or missed doses were all treatment naïve, mostly non-cirrhotic (8 of 9), and often anticipated concerns with forgetting their medications. CONCLUSIONS This qualitative study uncovered several unanticipated determinants of HCV treatment completion and provides rationale for several targeted interventions such as incorporating structured positive reinforcement.
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Séraphin MN, Hsu H, Chapman HJ, de Andrade Bezerra JL, Johnston L, Yang Y, Lauzardo M. Timing of treatment interruption among latently infected tuberculosis cases treated with a nine-month course of daily isoniazid: findings from a time to event analysis. BMC Public Health 2019; 19:1214. [PMID: 31481046 PMCID: PMC6724263 DOI: 10.1186/s12889-019-7524-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 08/21/2019] [Indexed: 12/05/2022] Open
Abstract
Background Treatment of latent tuberculosis infection (LTBI) in high-risk groups is an effective strategy for TB control and elimination in low incidence settings. A nine-month course of daily isoniazid (INH) has been the longest prescribed therapy; however, completion rates are suboptimal. We need data to guide TB program outreach efforts to optimize LTBI treatment completion rates. Methods We pooled seven (2009–2015) years of LTBI treatment outcome data. We computed the probability of INH treatment disruption over time by patient demographic and clinical risk factors. We used log-rank tests and Cox proportional hazards models to assess the risk factors for treatment disruption. Results We analyzed data from 12,495 persons with complete data on INH treatment initiation. Pediatric cases (0–17 years), recent contacts of active TB patients, and non-U.S.-born adults living in the United States ≤5 years represented 25.2, 13.0, and 59.2% of the study population, respectively. Overall, 48.4% failed to complete therapy. The median treatment duration was 306 days (95% CI: 297, 315). A significant drop in adherence could be observed around day 30 of treatment initiation. Indeed, by day 30 of treatment, 17.0% (95% CI: 16.4, 17.7) of patients had defaulted on therapy. Pediatric patients (HR = 0.83, 95% CI: 0.78, 0.89), recent contacts (HR = 0.74, 95% CI: 0.68, 0.81), patients with diabetes (HR = 0.77, 95% CI: 0.60, 0.98), and patients with HIV (HR = 0.39, 95% CI: 0.30, 0.51) had a lower risk of treatment default. However, black patients (HR = 1.57, 95% CI: 1.44, 1.70), Hispanic patients (HR = 1.54, 95% CI: 1.43, 1.66), and non-U.S.-born persons living in the United States ≤5 years (HR = 1.25, 95% CI: 1.18, 1.32) were significantly more likely to default on therapy. Conclusions In this analysis of INH treatment outcome, we see high levels of treatment discontinuation. On average, patients defaulted on their prescribed nine-month daily INH therapy within 30 days of initiating treatment, and those at increased risk of progression to active disease were most likely to do so. We highlight the need to introduce patient-centered programs to increase treatment adherence in this population. Electronic supplementary material The online version of this article (10.1186/s12889-019-7524-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marie Nancy Séraphin
- Division of Infectious Diseases and Global Medicine, Department of Medicine, University of Florida, 2055 Mowry Road, Suite 250, Gainesville, FL, 32611, USA. .,Emerging Pathogens Institute, University of Florida, 2055 Mowry Road, Gainesville, FL, 32610, USA.
| | - HsiaoChu Hsu
- Division of Infectious Diseases and Global Medicine, Department of Medicine, University of Florida, 2055 Mowry Road, Suite 250, Gainesville, FL, 32611, USA.,Emerging Pathogens Institute, University of Florida, 2055 Mowry Road, Gainesville, FL, 32610, USA
| | - Helena J Chapman
- Division of Infectious Diseases and Global Medicine, Department of Medicine, University of Florida, 2055 Mowry Road, Suite 250, Gainesville, FL, 32611, USA.,Emerging Pathogens Institute, University of Florida, 2055 Mowry Road, Gainesville, FL, 32610, USA
| | - Joanne L de Andrade Bezerra
- Division of Infectious Diseases and Global Medicine, Department of Medicine, University of Florida, 2055 Mowry Road, Suite 250, Gainesville, FL, 32611, USA.,Emerging Pathogens Institute, University of Florida, 2055 Mowry Road, Gainesville, FL, 32610, USA
| | - Lori Johnston
- Bureau of Communicable Diseases, Tuberculosis Control Section, Florida Department of Health, 4052 Bald Cypress Way, Tallahassee, FL, 32399, USA
| | - Yang Yang
- Emerging Pathogens Institute, University of Florida, 2055 Mowry Road, Gainesville, FL, 32610, USA.,Department of Biostatistics, College of Public Health and Health Professions, University of Florida, 2055 Mowry Road, suite 250, Gainesville, FL, 32610, USA
| | - Michael Lauzardo
- Division of Infectious Diseases and Global Medicine, Department of Medicine, University of Florida, 2055 Mowry Road, Suite 250, Gainesville, FL, 32611, USA.,Emerging Pathogens Institute, University of Florida, 2055 Mowry Road, Gainesville, FL, 32610, USA
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Sweileh WM. Global research output on HIV/AIDS-related medication adherence from 1980 to 2017. BMC Health Serv Res 2018; 18:765. [PMID: 30305093 PMCID: PMC6180611 DOI: 10.1186/s12913-018-3568-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 09/26/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND "Human Immunodeficiency Virus (HIV)" and Acquired Immunodeficiency Syndrome (AIDS) are global health burden. Medication adherence in people living with HIV (PLWH) is a key element in reducing morbidity and mortality. Quantitative and qualitative assessment of research activity helps identify research gaps as well as efforts implemented to improve adherence behaviors in PLWH. The aim of the current study was to assess and analyze literature on HIV/AIDS-related medication adherence using bibliometric methods. METHODS SciVerse Scopus was used to accomplish the purpose of the current study. The study period included all times up to 2017. The analysis was restricted to documents published in academic journals. RESULTS Search strategy retrieved 3021 documents with an average of 32.5 citations per document, an h-index of 136, and an average of 4.4 authors per documents. The volume of literature on HIV/AIDS-related medication adherence constituted 1.3% of the overall HIV/AIDS literature. There was a significant (p < 0.01; r = 0.9) correlation between the growth of publications in AIDS-related stigma and medication adherence. The regions of America (567.9) had the highest research output per one million infected people (567.9) followed by the European region (314.3), Western Pacific Region (70.7), Eastern Mediterranean region (31.4), South East Asia (34.0), and Africa (19.3). Geographical distribution of publications showed an active contribution of certain countries in the Southern and Eastern region of Sub-Saharan Africa. Harvard University (8.4%; n = 254) was the most active institution. The top cited documents focused on the impact of adherence on disease outcome and the impact of text messages on improving medication adherence. CONCLUSION Research on medication adherence in PLWH showed regional variations. International research collaboration with high burden regions such as Sub-Saharan Africa needs to be strengthened to achieve the global target of ending AIDS as a public health threat by 2030.
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Affiliation(s)
- Waleed M Sweileh
- Department of Physiology, Pharmacology/Toxicology, Division of Biomedical Sciences, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine.
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12
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Almeida-Brasil CC, Ceccato MDGB, Battistella Nemes MI, Crosland Guimarães MD, de Assis Acurcio F. Improving community mobilization in HIV treatment management: practical suggestions from patients in Brazil. REVISTA PANAMERICANA DE SALUD PUBLICA = PAN AMERICAN JOURNAL OF PUBLIC HEALTH 2017; 41:e119. [PMID: 31384256 PMCID: PMC6645207 DOI: 10.26633/rpsp.2017.119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 01/15/2017] [Indexed: 11/24/2022]
Abstract
Objectives. To describe patients’ suggestions on improving the management of antiretroviral therapy (ART) and to identify the roles that key stakeholders should play in taking responsibility for those recommendations. Methods. This research was embedded within a national cross-sectional study on patient adherence to ART and the associated factors. A subsample of the study patients were asked to offer suggestions on how to improve daily management of ART, and their answers were analyzed using a content analysis approach. The recommendations were then interpreted in terms of who should be responsible for them, and the suggestions were organized into three levels: micro (patient), meso (health care team), and macro (researchers, policymakers, family, friends, and the general public). Results. Of the 552 participants from the subsample, 60% were male, their average age was 44.1 years, and 62% were nonadherent in at least at one of three dimensions (missing doses, improper timing, or improper dosing). The categories underlying the micro level were “believing in treatment efficacy,” “being motivated,” “accepting HIV status,” and “sharing experiences with other patients.” At the meso level the suggestion categories were “more information from health care providers” and “humanization of care.” The macro level categories were “social support and actions against stigma,” “research proposals,” and “improvement of health care services.” Conclusions. Patients are influenced by the health policies, care, and support offered by health care providers, organizations, policymakers, and communities. In turn, these stakeholders develop the policies and deliver their care and support based on the responses and actions of patients. All stakeholders should work together to engage, educate, and support patients in addressing ART management.
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Affiliation(s)
- Celline Cardoso Almeida-Brasil
- Universidade Federal de Minas Gerais, School of Medicine Department of Social and Preventive Medicine, Belo Horizonte Minas Gerais Brazil Universidade Federal de Minas Gerais, School of Medicine, Department of Social and Preventive Medicine, Belo Horizonte, Minas Gerais, Brazil
| | - Maria das Graças Braga Ceccato
- Universidade Federal de Minas Gerais, School of Medicine Department of Social and Preventive Medicine, Belo Horizonte Minas Gerais Brazil Universidade Federal de Minas Gerais, School of Medicine, Department of Social and Preventive Medicine, Belo Horizonte, Minas Gerais, Brazil
| | - Maria Inês Battistella Nemes
- Universidade de São Paulo, School of Medicine Department of Preventive Medicine, São Paulo São Paulo Brazil Universidade de São Paulo, School of Medicine, Department of Preventive Medicine, São Paulo, São Paulo, Brazil
| | - Mark Drew Crosland Guimarães
- Universidade Federal de Minas Gerais, School of Medicine Department of Social and Preventive Medicine, Belo Horizonte Minas Gerais Brazil Universidade Federal de Minas Gerais, School of Medicine, Department of Social and Preventive Medicine, Belo Horizonte, Minas Gerais, Brazil
| | - Francisco de Assis Acurcio
- Universidade Federal de Minas Gerais, School of Medicine Department of Social and Preventive Medicine, Belo Horizonte Minas Gerais Brazil Universidade Federal de Minas Gerais, School of Medicine, Department of Social and Preventive Medicine, Belo Horizonte, Minas Gerais, Brazil
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Callon W, Saha S, Wilson IB, Laws MB, Massa M, Korthuis PT, Sharp V, Cohn J, Moore RD, Beach MC. How does decision complexity affect shared decision making? An analysis of patient-provider antiretroviral initiation dialogue. PATIENT EDUCATION AND COUNSELING 2017; 100:919-926. [PMID: 28012679 PMCID: PMC5400677 DOI: 10.1016/j.pec.2016.12.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 12/14/2016] [Accepted: 12/15/2016] [Indexed: 05/25/2023]
Abstract
OBJECTIVES This study analyzed patient-provider dialogue regarding anti-retroviral therapy (ART) initiation, assessing the degree to which shared decision making (SDM) occurred. METHODS We analyzed 24 audio-recorded dialogues between 14 HIV providers and their patients regarding ART initiation. We coded transcribed dialogues for seven SDM elements. We stratified dialogues into three levels of decision complexity (basic, intermediate, complex) based on patient CD4 counts and evaluated SDM criteria fulfillment at each level of decision complexity. RESULTS There were five basic, twelve intermediate, and seven complex decisions in our sample. While only two met the defined criteria for SDM, the mean number of SDM elements present increased with each level of decision complexity. Discussion of the clinical issue requiring the decision occurred most frequently (88%), while discussion of pros/cons (13%), patient's understanding (21%), and decision alternatives (29%) occurred least frequently. CONCLUSION/PRACTICE IMPLICATIONS While few dialogues met the defined SDM criteria, providers are having conversations that respond to decision complexity. Clinicians should be aware that discussion of pros/cons, alternatives, and uncertainties are frequently skipped, even when these elements are clearly relevant, as in complex decisions. In addition, rhetorical questions to assess patient preferences and understanding are insufficient to fully engage patients in SDM.
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Affiliation(s)
- Wynne Callon
- Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Somnath Saha
- Portland VA Medical Center, Portland, OR, USA; Department of Medicine, Oregon Health Sciences University, Portland, OR, USA
| | - Ira B Wilson
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI, USA
| | - Michael Barton Laws
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI, USA
| | - Michele Massa
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - P Todd Korthuis
- Department of Medicine, Oregon Health Sciences University, Portland, OR, USA
| | | | - Jonathan Cohn
- Department of Medicine, Wayne State University, Detroit, MI, USA
| | - Richard D Moore
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Galárraga O, Gao B, Gakinya BN, Klein DA, Wamai RG, Sidle JE, Papas RK. Task-shifting alcohol interventions for HIV+ persons in Kenya: a cost-benefit analysis. BMC Health Serv Res 2017; 17:239. [PMID: 28351364 PMCID: PMC5371255 DOI: 10.1186/s12913-017-2169-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 03/17/2017] [Indexed: 12/18/2022] Open
Abstract
Background Among HIV+ patients, alcohol use is a highly prevalent risk factor for both HIV transmission and poor adherence to HIV treatment. The large-scale implementation of effective interventions for treating alcohol problems remains a challenge in low-income countries with generalized HIV epidemics. It is essential to consider an intervention’s cost-effectiveness in dollars-per-health-outcome, and the long-term economic impact —or “return on investment” in monetary terms. Methods We conducted a cost-benefit analysis, measuring economic return on investment, of a task-shifted cognitive-behavioral therapy (CBT) intervention delivered by paraprofessionals to reduce alcohol use in a modeled cohort of 13,440 outpatients in Kenya. In our base-case, we estimated the costs and economic benefits from a societal perspective across a six-year time horizon, with a 3% annual discount rate. Costs included all costs associated with training and administering task-shifted CBT therapy. Benefits included the economic impact of lowered HIV incidence as well as the improvements in household and labor-force productivity. We conducted univariate and multivariate probabilistic sensitivity analyses to test the robustness of our results. Results Under the base case, total costs for CBT rollout was $554,000, the value of benefits were $628,000, and the benefit-to-cost ratio was 1.13. Sensitivity analyses showed that under most assumptions, the benefit-to-cost ratio remained above unity indicating that the intervention was cost-saving (i.e., had positive return on investment). The duration of the treatment effect most effected the results in sensitivity analyses. Conclusions CBT can be effectively and economically task-shifted to paraprofessionals in Kenya. The intervention can generate not only reductions in morbidity and mortality, but also economic savings for the health system in the medium and long term. The findings have implications for other countries with generalized HIV epidemics, high prevalence of alcohol consumption, and shortages of mental health professionals. Trial registration This paper uses data derived from “Cognitive Behavioral Treatment to Reduce Alcohol Use Among HIV-Infected Kenyans (KHBS)” with ClinicalTrials.gov registration NCT00792519 on 11/17/2008; and preliminary data from “A Stage 2 Cognitive-behavioral Trial: Reduce Alcohol First in Kenya Intervention” (NCT01503255, registered on 12/16/2011).
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Affiliation(s)
- Omar Galárraga
- Brown University School of Public Health, G-S121-7, 121 South Main Street, Providence, RI, 02912, USA
| | - Burke Gao
- Brown University School of Public Health, G-S121-7, 121 South Main Street, Providence, RI, 02912, USA.,Brown University Alpert Medical School, 222 Richmond Street, Providence, RI, 02912, USA
| | - Benson N Gakinya
- Moi University & Moi Teaching and Referral Hospital, Nandi Rd, Eldoret, Kenya
| | | | - Richard G Wamai
- Northeastern University, Integrated Initiative for Global Health, 360 Huntington Avenue, 220G RP, Boston, MA, 02115, USA
| | - John E Sidle
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Rebecca K Papas
- Department of Psychiatry and Human Behavior, Brown University Alpert Medical School, Providence, RI, 02912, USA.
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15
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Enriquez M, Cheng AL, Banderas J, Farnan R, Chertoff K, Hayes D, Ortego G, Moreno J, Peterson J, McKinsey D. A Peer-Led HIV Medication Adherence Intervention Targeting Adults Linked to Medical Care but without a Suppressed Viral Load. J Int Assoc Provid AIDS Care 2015; 14:441-8. [PMID: 25412724 PMCID: PMC5677528 DOI: 10.1177/2325957414558301] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Non-adherence to antiretroviral (ART) treatment remains a prevalent problem even among the segment of the U.S. HIV population that is 'linked' to medical care. METHODS Controlled pilot feasibility study with ART experienced adult patients (n = 20) linked to HIV medical care without suppressed viral load. Patients were randomized to a peer-led HIV medication adherence intervention named `Ready' or a time equivalent `healthy eating' control arm. Lay individuals living with HIV were trained to facilitate `Ready'. RESULTS Patients had been prescribed a mean of three prior ART regimens. The group randomized to `Ready' had significantly improved adherence. MEMS and pharmacy refill data correlated with viral load log drop. Higher readiness for healthful behavior change correlated with viral load drop and approached significance. CONCLUSION A peer-led medication adherence intervention had a positive impact among adults who had experienced repeated non-adherence to HIV treatment. A larger study is needed to examine intervention dissemination and efficacy.
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Affiliation(s)
- Maithe Enriquez
- Sinclair School of Nursing, University of Missouri, Columbia, MO, USA
| | - An-Lin Cheng
- School of Nursing, School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Julie Banderas
- School of Nursing, School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Rose Farnan
- Infectious Disease Clinic, Truman Medical Center, Hospital Hill, Kansas City, MO, USA
| | - Keyna Chertoff
- School of Nursing, School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Deana Hayes
- Infectious Disease Clinic, Truman Medical Center, Hospital Hill, Kansas City, MO, USA
| | - Gerry Ortego
- Infectious Disease Clinic, Truman Medical Center, Hospital Hill, Kansas City, MO, USA
| | - Jose Moreno
- School of Nursing, School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Jane Peterson
- School of Nursing, School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
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Billioux A, Nakigozi G, Newell K, Chang LW, Quinn TC, Gray RH, Ndyanabo A, Galiwango R, Kiggundu V, Serwadda D, Reynolds SJ. Durable Suppression of HIV-1 after Virologic Monitoring-Based Antiretroviral Adherence Counseling in Rakai, Uganda. PLoS One 2015; 10:e0127235. [PMID: 26011158 PMCID: PMC4444255 DOI: 10.1371/journal.pone.0127235] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 04/12/2015] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES HIV viral load is recommended for monitoring antiretroviral treatment and identifying treatment failure. We assessed the durability of viral suppression after viral load-triggered adherence counseling among patients with HIV viremia 6 months after ART initiation. DESIGN Observational cohort enrolled in an antiretroviral treatment program in rural Uganda. METHODS Participants who underwent routine viral load determination every 24 weeks and had at least 48 weeks of follow-up were included in this analysis. Patients with viral loads >400 copies/ml at 24 weeks of treatment were given additional adherence counseling, and all patients were followed to assess the duration of viral suppression and development of virologic failure. RESULTS 1,841 participants initiating antiretroviral therapy were enrolled in the Rakai Health Sciences Program between June 2005 and June 2011 and were followed with viral load monitoring every 24 weeks. 148 (8%) of patients did not achieve viral suppression at 24 weeks and were given additional adherence counseling. 85 (60%) of these patients had undetectable viral loads at 48 weeks, with a median duration of viral suppression of 240 weeks (IQR 193-288 weeks). Failure to achieve an undetectable viral load at 48 weeks was associated with age <30 years and 24 week viral load >2,000 copies/ml in multivariate logistic regression analysis. CONCLUSIONS The majority of patients with persistent viremia who were provided adherence counseling achieved robust viral suppression for a median 4.6 years. Access to virologic monitoring and adherence counseling is a priority in resource-limited settings.
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Affiliation(s)
- Alexander Billioux
- Johns Hopkins School of Medicine, Baltimore, Maryland
- Rakai Health Sciences Program, Rakai, Uganda
| | | | - Kevin Newell
- Clinical Research Directorate/Clinical Monitoring Research Program, Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, Frederick, Maryland
| | - Larry W. Chang
- Johns Hopkins School of Medicine, Baltimore, Maryland
- Rakai Health Sciences Program, Rakai, Uganda
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Thomas C. Quinn
- Johns Hopkins School of Medicine, Baltimore, Maryland
- Rakai Health Sciences Program, Rakai, Uganda
- National Institute for Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Ron H. Gray
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | | | | | - David Serwadda
- Rakai Health Sciences Program, Rakai, Uganda
- Makerere University College of Health Sciences, School of Public Health, Kampala, Uganda
| | - Steven J Reynolds
- Johns Hopkins School of Medicine, Baltimore, Maryland
- Rakai Health Sciences Program, Rakai, Uganda
- National Institute for Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
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Igumbor J, Pascoe S, Rajap S, Townsend W, Sargent J, Darkoh E. A South African public-private partnership HIV treatment model: viability and success factors. PLoS One 2014; 9:e110635. [PMID: 25329384 PMCID: PMC4203815 DOI: 10.1371/journal.pone.0110635] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 09/24/2014] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION The increasing number of people requiring HIV treatment in South Africa calls for efficient use of its human resources for health in order to ensure optimum treatment coverage and outcomes. This paper describes an innovative public-private partnership model which uses private sector doctors to treat public sector patients and ascertains the model's ability to maintain treatment outcomes over time. METHODS The study used a retrospective design based on the electronic records of patients who were down-referred from government hospitals to selected private general medical practitioners (GPs) between November 2005 and October 2012. In total, 2535 unique patient records from 40 GPs were reviewed. The survival functions for mortality and attrition were calculated. Cumulative incidence of mortality for different time cohorts (defined by year of treatment initiation) was also established. RESULTS The median number of patients per GP was 143 (IQR: 66-246). At the time of down-referral to private GPs, 13.8% of the patients had CD4 count <200 cell/mm(3), this proportion reduced to 6.6% at 12 months and 4.1% at 48 months. Similarly, 88.4% of the patients had suppressed viral load (defined as HIV-1 RNA <400 copies/ml) at 48 months. The patients' probability of survival at 12 and 48 months was 99.0% (95% CI: 98.4%-99.3%) and 89.0% (95% CI: 87.1%-90.0%) respectively. Patient retention at 48 months remained high at 94.3% (95% CI: 93.0%-95.7%). CONCLUSIONS The study findings demonstrate the ability of the GPs to effectively maintain patient treatment outcomes and potentially contribute to HIV treatment scale-up with the relevant support mechanism. The model demonstrates how an assisted private sector based programme can be effectively and efficiently used to either target specific health concerns, key populations or serve as a stop-gap measure to meet urgent health needs.
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Affiliation(s)
- Jude Igumbor
- Research and Development Department, BroadReach Healthcare, Cape Town, South Africa
| | - Sophie Pascoe
- Research and Development Department, BroadReach Healthcare, Cape Town, South Africa
| | - Shuabe Rajap
- Operations Department, BroadReach Healthcare, Cape Town, South Africa
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