scholarly journals The Comparison of Teen Clubs vs. Standard Care on Treatment Outcomes for Adolescents on Antiretroviral Therapy in Windhoek, Namibia

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Farai K. Munyayi ◽  
Brian E. van Wyk
Keyword(s):  
Antiretroviral Therapy ◽  
Treatment Outcomes ◽  
Standard Care ◽  
Psychosocial Support ◽  
Peer Group ◽  
Cohort Analysis ◽  
Hiv Disclosure ◽  
Virologic Suppression ◽  
Art Adherence ◽  
Adherence Support

Background. Adolescents living with HIV (ALHIV) are challenged to adhere to antiretroviral therapy (ART) and achieve and maintain virologic suppression. Group-based adherence support interventions, such as adherence clubs, have been shown to improve long-term adherence in ART patients. The teen club intervention was introduced in 2010 in Namibia to improve treatment outcomes for ALHIV by providing adherence support in a peer-group environment. Adolescents who have completed the full HIV disclosure process can voluntarily join the teen clubs. The current study compared treatment outcomes of ALHIV receiving ART at a specialized paediatric HIV clinic between 1 July 2015 and 30 June 2017 in Windhoek, Namibia. Methods. A retrospective cohort analysis was conducted on routine patient data extracted from the electronic Patient Monitoring System, individual Patient Care Booklets, and teen club attendance registers. A sample of 385 adolescents were analysed: 78 in teen clubs and 307 in standard care. Virologic suppression was determined at 6, 12, and 18 months from study start date, and compared by model of care, age, sex, disclosure status, and ART regimen. Comparisons between adolescents in teen clubs and those receiving standard care were performed using the chi-square test, and risk ratios were calculated to analyze differences in ART adherence and virologic suppression. Results. The average clinician-measured ART adherence was 89% good, 6% fair, and 5% poor amongst all adolescents, with no difference between teen club members and adolescents in standard care ( p  = 0.277) at 3 months. Virologic suppression over the 2-year observation period was 87% (68% fully suppressed <40 copies/ml and 19% suppressed between 40–999 copies/ml), with no difference between teen club members and those in standard care. However, there were statistically significant differences in virologic suppression levels between the younger (10–14 years) adolescents and older (15–19 years) adolescents at 6 months ( p  = 0.015) and at 12 months ( p  = 0.021) and between adolescents on first-line and second-line ART regimen at 6 months ( p  = 0.012), 12 months ( p  = 0.004), and 18 months ( p  = 0.005). Conclusion. The teen club model delivering psychosocial support only did not improve adherence and virologic suppression levels for adolescents in a specialized paediatric ART clinic, neither were they inferior to standard care. Considering the limitations of this study, teen clubs may still hold potential for improving adherence and virologic suppression levels for older adolescents, and more robust research on adherence interventions for adolescents with higher methodological quality is required.

Occupational barriers to accessing and adhering to antiretroviral therapy for female sex workers living with HIV in South Africa

2020 ◽  
Vol 77 (2) ◽  
pp. 100-106 ◽  
Author(s):  
Lauren E Parmley ◽  
Carly A Comins ◽  
Katherine Young ◽  
Mfezi Mcingana ◽  
Deliwe Rene Phetlhu ◽  
...  
Keyword(s):  
South Africa ◽  
Antiretroviral Therapy ◽  
Coping Strategies ◽  
Sex Workers ◽  
Female Sex Workers ◽  
Hiv Disclosure ◽  
Female Sex ◽  
Adherence Support ◽  
Wage Loss ◽  
Living With Hiv

ObjectivesWhile female sex workers (FSW) are nearly 14 times more likely to be living with HIV than non-FSW, less than 40% of FSW living with HIV are on antiretroviral therapy (ART). We sought to understand how the work environment influences ART access and adherence for FSW in preparation for the Siyaphambili trial.MethodsFSW living with HIV (n=24) and key informants (n=15) were recruited to participate in semistructured in-depth interviews using maximum variation and snowball sampling, respectively. FSW were recruited on key variants including type of sex work venue, primary work time and history of ART use. Data were collected between September and November 2017 in Durban, South Africa. Interviews were audio-recorded, transcribed and translated. Data were then coded applying grounded theory in Atlas.ti.ResultsFSW experienced occupational barriers to adherence including work-related migration, substance use and theft of ART on the job. Fear of wage loss due to HIV disclosure to clients and brothel managers prevented some FSW from accessing ART at their clinic and taking medications while working. FSW employed coping strategies to overcome barriers including sharing ART with colleagues, carrying small supplies of ART and visiting the clinic prior to appointments for ART refills. Further, some FSW received adherence support from colleagues who were also living with HIV.ConclusionsConsidering these occupational pressures on FSW and supporting positive coping strategies are important when designing and implementing HIV treatment programmes. Findings suggest strengthening social cohesion and supporting differentiated care efforts to improve HIV outcomes among FSW living with HIV.

scholarly journals Recruitment of Youth Living With HIV to Optimize Adherence and Virologic Suppression: Testing the Design of Technology-Based Community Health Nursing to Improve Antiretroviral Therapy (ART) Clinical Trials (Preprint)

2020 ◽  
Author(s):  
Allison Lorna Agwu ◽  
Hasiya Eihuri Yusuf ◽  
Lawrence D'Angelo ◽  
Mobeen Rathore ◽  
Jeanette Marchesi ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Antiretroviral Therapy ◽  
Community Health ◽  
Control Group ◽  
Virologic Suppression ◽  
Art Adherence ◽  
Term Survival ◽  
Community Health Nursing ◽  
Health Nursing

BACKGROUND Despite advances in HIV diagnosis and treatment, adolescents and young adults 12-25 years old have high HIV incidence, poor engagement and retention in treatment, and low rates of adherence and virologic suppression when compared to their older counterparts. HIV has emerged as a chronic disease for which antiretroviral therapy (ART) adherence is critical for virologic suppression and long-term survival. Virologic suppression has been elusive for many youth with HIV (YHIV). Novel strategies designed to facilitate health care systems’ support for YHIV between medical visits are essential for improving ART adherence, virologic suppression, and long-term survival. OBJECTIVE The aim of this study is to compare the effectiveness of a technology-enhanced community health nursing intervention (TECH2CHECK) to a standard of care (SOC) control group for improving ART adherence and subsequent viral suppression using a randomized trial design. The objectives are to assess the feasibility, acceptability, and cost-effectiveness of TECH2CHECK as compared to SOC for management of HIV in the outpatient setting and to examine the sustainability of self-care behavior, adherence, and virologic suppression among youth following the intervention period. METHODS We will recruit 120 adherence-challenged YHIV being followed at clinics specializing in HIV care in the Baltimore-Washington metropolitan area and in Jacksonville. Eligible participants complete an audio, computer-assisted self-interview and are randomized to either TECH2CHECK intervention or the SOC (60 participants in each arm). The primary outcome of interest is virologic suppression (viral load &lt;20 copies/mL) and improved treatment adherence. Participants in the intervention arm receive community health nursing visits at 2 weeks, 6 weeks, 10 weeks, 14 weeks, and 26 weeks. The intervention arm also receives SMS messaging comprising daily adherence and appointment reminders and positive reinforcement for medication adherence daily for 2 weeks, on alternate days for 2 weeks, thrice weekly for 1 month, weekly for 3 months, and every 2 weeks for the rest of the study duration. The control group receives appointment reminders and SOC per clinic protocol. Exploratory analysis will be conducted to determine differences in medication adherence and virologic suppression in the 2 arms and to assess cost-effectiveness and study feasibility and acceptability. RESULTS In the first 23 months of the study (July 2018-April 2020), 56 (55%) of 102 eligible patients were enrolled and randomized. At present, participating youths are primarily African American (53/56, 95%), male (37/56, 66%), and ≥18 years old (53/56, 95%). Follow-up study visits, as required per the protocol, have been completed by 77% (43/56), 94% (45/48), 95% (37/39), 96% (24/25), and 100% (10/10) of participants at the 1-month, 3-month, 6-month, 12-month, and 18-month follow-ups, respectively. CONCLUSIONS Preliminary accrual and retention data suggest that TECH2CHECK is feasible and acceptable. CLINICALTRIAL ClinicalTrials.gov NCT03600103 https://clinicaltrials.gov/ct2/show/NCT03600103 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/23480

scholarly journals Association of Suboptimal Antiretroviral Therapy Adherence With Inflammation in Virologically Suppressed Individuals Enrolled in the SMART Study

2017 ◽  
Vol 5 (1) ◽  
Author(s):  
Jose R Castillo-Mancilla ◽  
Andrew N Phillips ◽  
James D Neaton ◽  
Jacqueline Neuhaus ◽  
Simon Collins ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Confidence Interval ◽  
Cohort Studies ◽  
Plasma Concentrations ◽  
Virologic Suppression ◽  
Art Adherence ◽  
Antiretroviral Therapy Adherence ◽  
Smart Study ◽  
Hiv 1 ◽  
D Dimer

Abstract Suboptimal (ie, &lt;100%) antiretroviral therapy (ART) adherence has been associated with heightened inflammation in cohort studies, even among people with virologic suppression. We aimed to evaluate this association among participants in the Strategies for Management of Antiretroviral Therapy (SMART) study who had virologic suppression (HIV-1 VL &lt; 200 copies/mL) at enrollment. Based on self-reported adherence (7-day recall), plasma concentrations of interleukin 6 and D-dimer were 9% (95% confidence interval [CI], 1%–18%; P = .02) and 11% (95% CI, 1%–22%; P = .03) higher in participants who reported suboptimal vs 100% adherence, respectively. These findings confirm previous observations and support the hypothesis that suboptimal ART adherence, even in the context of virologic suppression, may have significant biological consequences. ClinicalTrials.gov number NCT00027352

scholarly journals HIV virological non-suppression and factors associated with non-suppression among adolescents and adults on antiretroviral therapy in northern Ethiopia: a retrospective study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Abraham Aregay Desta ◽  
Tewolde Wubayehu Woldearegay ◽  
Nesredin Futwi ◽  
Gebrecherkos Teame Gebrehiwot ◽  
Goyitom Gebremedhn Gebru ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Antiretroviral Drugs ◽  
Resistance Pattern ◽  
Northern Ethiopia ◽  
Art Adherence ◽  
Adherence Level ◽  
Factors Associated ◽  
Number Of Patients ◽  
Adherence Support ◽  
Adolescents And Adults

Abstract Background Despite the benefits of Antiretroviral Therapy (ART), there is a growing concern of treatment failure. This study aimed to assess viral non suppression rate and factors associated with HIV viral non suppression among adolescents and adults on ART in Northern Ethiopia. Methods A retrospective cross sectional study was done on 19,525 study subjects. All the data in the database of Tigray Health Research Institute was exported to Microsoft excel 2010 and then data verification and filtration were done before exporting to STATA 14.0 for analysis. Generalized Estimating Equation (GEE) logistic regression was used for statistical modeling of viral non suppression. Results A total of 5153 (26.39%; 95%CI (25.77%, 27.02)) patients had no viral suppression despite being on ART. Being male (AOR = 1.27, 95% CI: 1.18, 1.37), 15–19 years of age (AOR = 4.86, 95%CI: 3.86, 6.12), patients from primary hospital (AOR = 1.26, 95%CI: 1.05, 1.52), WHO staging II (AOR = 1.31, 95%CI: 1.10, 1.54), poor ART adherence level (AOR = 2.56, 95%CI: 1.97, 3.33), fair ART adherence level (AOR = 1.61, 95%CI: 1.36, 1.90), baseline CD-4 count of < 200 cells/micro liter (AOR = 1.33, 95%CI: 1.14, 1.54), recent CD-4 count of < 200 cells/micro liter (AOR = 3.78, 95%CI: 3.34, 4.27), regimen types: 1c (AZT-3TC-NVP) (AOR = 1.32, 95%CI: 1.22, 1.44), 2 h (TDF-3TC-ATV/R) (AOR = 1.79, 95%CI: 1.27, 2.52) and declined immunological responses after ART initiation (AOR = 1.45, 95%CI: 1.30, 1.61) were significantly associated with viral non-suppression. Conclusions The virological non suppression was high which makes it less likely to achieve the third 90 UNAIDS target. Being male, patients with WHO staging II and poor ART adherence level were significantly associated with viral non suppression. Therefore, intensive adherence support and counseling should be provided. It is also a high time to determine the antiretroviral drugs resistance pattern given the fact that a large number of patients had virological non suppression.

scholarly journals Delivery of HIV Antiretroviral Therapy Adherence Support Services by HIV Care Providers in the United States, 2013 to 2014

2017 ◽  
Vol 16 (6) ◽  
pp. 624-631 ◽  
Author(s):  
John Weiser ◽  
Linda Beer ◽  
John T. Brooks ◽  
Kathleen Irwin ◽  
Brady T. West ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Nurse Practitioners ◽  
Support Services ◽  
International Association ◽  
The United States ◽  
Hiv Care ◽  
Art Adherence ◽  
Care Providers ◽  
Adherence Support ◽  
Hiv Antiretroviral Therapy

Background: Little is known about clinicians’ adoption of recommendations of the International Association of Providers of AIDS Care and others for supporting adherence to antiretroviral therapy (ART). Methods: We surveyed a probability sample of US HIV care providers to estimate the percentage offering 3 ART adherence support services to most or all patients and assessed the characteristics of providers offering all 3 services (comprehensive support) to most or all patients. Results: Almost all providers (95.5%) discussed ART adherence at every visit, 60.1% offered advice about tools to increase adherence, 53.5% referred nonadherent patients for supportive services, and 42.8% provided comprehensive support. Nurse practitioners were more likely to offer comprehensive support as were providers who practiced at Ryan White HIV/AIDS Program-funded facilities, provided primary care, or started caring for HIV-infected patients within 10 years. Conclusion: Less than half of HIV care providers offered comprehensive ART adherence support. Certain subgroups may benefit from interventions to increase delivery of adherence support.

scholarly journals Patient-Provider Communication and Information, Motivation, and Behavioral Skills in HIV-Positive Adults Initiating Antiretroviral Therapy in Haiti

2020 ◽  
Vol 19 ◽  
pp. 232595822095263
Author(s):  
Megan K. Ramaiya ◽  
Elizabeth Haight ◽  
Jane M. Simoni ◽  
Jean Marcxime Chéry ◽  
Witson Dervis ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Hiv Treatment ◽  
Provider Communication ◽  
Art Adherence ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Behavioral Skills ◽  
Adherence Support ◽  
Hiv Positive Adults ◽  
Patient Provider Communication

While Haiti has scaled up use of antiretroviral therapy (ART), current studies suggest sub-optimal adherence threatens long-term viral suppression in this understudied setting. Patient-provider communication (PPC) and information, motivation, and behavioral skills (IMB) have been implicated in ART adherence globally. However, no studies have examined their relevance in Haiti. The present mixed-methods study utilized cross-sectional survey data from 128 ART-initiating patients at 2 large HIV treatment sites in Haiti, as well as observational data from 12 clinic visits, to document associations between adherence-related PPC and IMB. Multivariate regression analyses suggested that PPC is associated with IMB constructs. At the bivariate level, more effective PPC was associated with higher levels of adherence-related information and motivation, but not behavioral skills. Observational findings indicate infrequent and non-collaborative adherence support. Taken together, findings lay the groundwork for additional research in the area of PPC, IMB, and ART adherence in Haiti.

scholarly journals Assessment of Antiretroviral therapy Initiation among pregnant Women under Option B+ Approach; Viral Load and CD4 Count Outcomes in selected Hospitals of West Zone Oromia, Ethiopia: Quantitative Prospective Cohort Study Design

2019 ◽  
Author(s):  
Dereje Bayissa Demissie ◽  
Gizachew Abdissa Bulto ◽  
Wagi Tosisa Mekuria ◽  
Fikru Negassa Dufera
Keyword(s):  
Viral Load ◽  
Antiretroviral Therapy ◽  
Pregnant Women ◽  
Treatment Outcomes ◽  
Prospective Cohort ◽  
Cd4 Count ◽  
Hiv Positive ◽  
Virologic Suppression ◽  
Art Initiation ◽  
Study Results

Abstract Abstract Background: Antiretroviral therapy (ART) is effective for elimination of mother-to-child transmission (eMTCT) of human immunodeficiency virus (HIV) infection, reducing infant mortality and ensuring maternal virologic suppression. While pregnant women require lifelong ART immediately they test HIV positive (“test and treat”) under Option B+ programs, eMTCT programs face challenges and information on the relationship between the time to ART initiation following HIV testing and treatment outcomes is limited in Ethiopia Methods: A quantitative prospective cohort design was employed to conduct the study. Five randomly selected Hospitals providing Option B+ services with routine viral load assessment by Oromia regional Laboratory (ORL) from January 2016 to January 2017 was randomly selected. Bivariate and multivariable analyses were conducted to determine factors affecting the time to ART initiation following an HIV test and logistic regression used to determine the correlation between time and treatment outcomes. Results: The study results produced and evidence of a mean VL (copies/ml) of 197.27 copies/ml. Respondents that were on ART for a shorter period ≤37 months had the least proportion of women 31% were suppressed with VL<1000 copies/ml compared to those on ART for >38 months (58.7%) were suppressed. The median (IQR) CD4 count change or difference among women that had initial and last CD4 was 581 cells/μl and mean of current CD4 count 629.17ceels/ml3 and more than 85.3% had increase CD4 count. Therefore, in this study identified that factors associated with viral load response were poor /fair adherence missing doses in the past month, missing appointments, baseline CD4 and maternal months on ART were statistically significant among HIV positive pregnant women that initiated lifelong ART on option B+ in Ethiopia. Conclusion: The study results demonstrated that HIV positive pregnant women Study results indicate that majority of the respondents 89.7% were suppressed of which 80.3% were undetectable (VL= 0 copies /ml3 and 85.3% had increased CD4 count and 10.3% were not suppressed (VL >1000 copies/ml). Therefore, strategies aimed at improving adherence among women on option B+ are to ensure that these women achieve adequate immunological outcomes. Keywords: ART Initiation Pregnant Women Option B +, Viral Load, CD4 Count

scholarly journals Facilitators and barriers to antiretroviral therapy adherence among HIV-positive adolescents living in Tanzania

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Cosette Audi ◽  
Ola Jahanpour ◽  
Gretchen Antelman ◽  
Laura Guay ◽  
Mastidia Rutaihwa ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Support Groups ◽  
Support Group ◽  
Psychosocial Support ◽  
Virologic Failure ◽  
Positive Influence ◽  
Hiv Positive ◽  
Art Adherence ◽  
Antiretroviral Therapy Adherence ◽  
Group Experiences

Abstract Background Adolescents living with HIV face substandard outcomes along the continuum of care, including higher rates of poor adherence and virologic failure. Support groups have been identified as a method to improve adherence, but there is insufficient evidence regarding their effectiveness. This study seeks to examine the protective influences for and barriers to antiretroviral therapy (ART) adherence in HIV-positive adolescents living in Tanzania. Methods This is a qualitative study conducted in Tanzania from January to March 2018. The sample of adolescents aged 10-19 (n = 33) was purposefully selected based on age, gender, and support group attendance to capture a broad range of experiences. Participants completed an in-depth interview, covering topics such as retention in HIV services, support group experiences, and joys and challenges of adolescent life. Interviews were coded and themes related to ART adherence were identified and summarized. Results Support groups helped promote adherence by improving adolescents’ knowledge and confidence. Participants associated joining support groups with an improvement in health. Almost every participant described the significant positive influence a treatment supporter had on adherence. Adolescents’ daily schedules and emotional state served as a barrier to adherence. Furthermore, adherence was negatively impacted by participants’ fear of accidental disclosure. Conclusion Logistical and psychosocial factors can hinder adherence. Interventions that provide both education and psychosocial support, such as peer support groups, have the potential to improve health outcomes for this population, but may not address more persistent barriers to adherence rooted in lack of treatment support from family members or friends who have not been disclosed to, or lack of transportation funds/food security.

scholarly journals Interactive Mobile Phone HIV Adherence Support for Men who Have Sex with Men in the Philippines: Intervention Development and Pilot Testing in the Philippines Connect for Life Study (Preprint)

2021 ◽  
Author(s):  
Cara O'Connor ◽  
Katerina Leyritana ◽  
Aoife M Doyle ◽  
James J Lewis ◽  
Randeep Gill ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Focus Group ◽  
Mobile Phone ◽  
The Philippines ◽  
Art Adherence ◽  
Pilot Phase ◽  
Focus Group Discussions ◽  
Group Discussions ◽  
Adherence Support ◽  
Sex With Men

BACKGROUND The Philippines HIV epidemic is one of the fastest growing globally, and infections among men who have sex with men (MSM) are rising at an alarming rate. The World Health Organization (WHO) recommends use of mobile phone health technologies (mHealth) to engage patients in care and ensure high levels of adherence to antiretroviral therapy (ART). Existing mHealth interventions can be adapted and tailored to the context and population served. OBJECTIVE To create a locally tailored intervention using a mobile phone platform to support treatment adherence for HIV patients on antiretroviral therapy (ART) in the Philippines. METHODS A mixed-methods approach guided by the Behavior Change Wheel (BCW) framework was used to adapt an existing mHealth adherence support platform for the local setting and target population. Literature review, retrospective clinical record review, and focus group discussions with patients were conducted to understand the drivers of ART adherence and tailor the intervention accordingly. The resulting intervention was pilot tested for eight weeks, followed by focus group discussions with patients who received the intervention to assess the acceptability of the design. RESULTS Key issues contributing to nonadherence included side effects, lack of behavioral skills for pill taking, social support, metal health, and substance use. Patients identified mHealth as an acceptable mode of intervention delivery, and wanted the mHealth services to be highly personalizable. The study team, clinicians, and software developers integrated these findings into the intervention, which included a menu of services: pill reminders, health tips, adherence feedback, appointment reminders, and symptom reporting. During the pilot phase, technical issues in the interactive voice response system (IVRS) were identified and addressed. Patients who participated in the pilot phase expressed a preference for short message service (SMS) over IVRS. Patients responded positively to the appointment reminders and health tips, while patient feedback on daily/weekly pill reminders and adherence feedback was mixed. CONCLUSIONS The mobile phone-based SMS and IVRS intervention was acceptable to MSM in Manila, Philippines, and qualitative analysis suggested the intervention helped promote ART adherence and appointment attendance.

scholarly journals A Facility-based Family Support Intervention to Improve Treatment Outcomes for Adolescents on Antiretroviral Therapy in the Cape Metropole, South Africa

2021 ◽  
Vol 20 ◽  
pp. 232595822110592
Author(s):  
Zaida Orth ◽  
Brian van Wyk
Keyword(s):  
Antiretroviral Therapy ◽  
Treatment Outcomes ◽  
Family Support ◽  
Health Workers ◽  
Well Being ◽  
Hiv Status ◽  
Individual Interviews ◽  
Adherence Support ◽  
Immunodeficiency Virus ◽  
Adults And Children

Adolescents living with human immunodeficiency virus (HIV) (ALHIV) globally, report worse treatment outcomes compared to adults and children on antiretroviral therapy (ART). We conducted a photovoice study with eighteen ALHIV to explore experiences and challenges of being on ART, and individual interviews with 5 health workers to describe the challenges in treating ALHIV. The facility implemented the Family club intervention to facilitate caregivers (parent/guardians) supporting ALHIV on treatment. The health workers revealed that “ disclosing HIV status” to children was the biggest challenge for caregivers and health workers. Participating ALHIV reported that family support and having a positive mentality were instrumental for continued treatment adherence. However, disclosure of HIV status to friends remained a challenge due to pervasive community stigma. Treatment fatigue and side- effects were also barriers to adherence. Family support was instrumental in facilitating adherence support for ALHIV. However, this (intervention) should include peer support to improve positive mental well-being in ALHIV.

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