Meeting the needs of young Latino gay, bisexual, and other men who have sex with men (MSM) and transgender women living with HIV through the weCare intervention in the United States (US)

OBJECTIVE

Young gay, bisexual, and other MSM (men who have sex with men) and transgender women in the United States (US) who are living with HIV, and particularly those who are Latino, have low rates of viral suppression. The weCare intervention uses social media to increase HIV care engagement.

METHOD

We used community-based participatory research to develop the intervention as well as theory-based social media messages tailored to each participant's unique context. We analyzed elements and characteristics of weCare, messages sent by the Cyber Health Educator (CHE), and lessons learned to meet the needs of Latino participants living with HIV.

RESULTS

We identified 6 core elements, 5 key characteristics, effective social media messages used in implementation, and 8 important lessons regarding relationships between the CHE and HIV clinics, the CHE and participants, and participants and the health system.

CONCLUSIONS

Social media offers a promising platform to retain young Latino gay bisexual and other MSM and transgender women living with HIV in care and achieve viral suppression.

Adherence clubs for long-term provision of antiretroviral therapy: cost-effectiveness and access analysis from Khayelitsha, South Africa

OBJECTIVES

As the scale of the South African HIV epidemic calls for innovative models of care that improve accessibility for patients while overcoming chronic human resource shortages, we (i) assess the cost-effectiveness of lay health worker-led group adherence clubs, in comparison with a nurse-driven 'standard of care' and (ii) describe and evaluate the associated patient cost and accessibility differences.

METHODS

Our cost-effectiveness analysis compares an 'adherence club' innovation to conventional nurse-driven care within a busy primary healthcare setting in Khayelitsha, South Africa. In each alternative, we calculate provider costs and estimate rates of retention in care and viral suppression as key measures of programme effectiveness. All results are presented on an annual or per patient-year basis. In the same setting, a smaller sample of patients was interviewed to understand the direct and indirect non-healthcare cost and access implications of the alternatives. Access was measured using McIntyre and colleagues' 2009 framework.

RESULTS

Adherence clubs were the more cost-effective model of care, with a cost per patient-year of $300 vs. $374 and retention in care at 1 year of 98.03% (95% CI 97.67-98.33) for clubs vs. 95.49% (95% CI 95.01-95.94) for standard of care. Viral suppression in clubs was 99.06% (95% CI 98.82-99.27) for clubs vs. 97.20% (95% CI 96.81-97.56) for standard of care. When interviewed, club patients reported fewer missed visits, shorter waiting times and higher acceptability of services compared to standard of care.

CONCLUSIONS

Adherence clubs offer the potential to enhance healthcare efficiency and patient accessibility. Their scale-up should be supported.