Associations Between Patterns of Alcohol Use and Viral Load Suppression Amongst Women Living with HIV in South Africa

Myers, Bronwyn; Lombard, Carl; Joska, John A.; Abdullah, Fareed; Naledi, Tracey; Lund, C; Williams, Petal Petersen; Stein, Dan J.; Sorsdahl, Katherine

doi:10.1007/s10461-021-03263-3

Cited by 30 publications

(26 citation statements)

References 51 publications

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“…Previous studies have alluded to similar reasons for non-suppression of viral load in many African countries. 55,56,57 If documentation is done properly, appropriate actions are taken such as enhanced adherence counselling for non-adherent clients. In cases of non-suppression of virus, Dolutegravir-based combination pack can be introduced as recommended by NACP.…”

Section: Discussionmentioning

confidence: 99%

Quality of antiretroviral therapy services in Ghana: Implications for the HIV response in resource-constrained settings

et al. 2021

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Objective: Number of People Living with Human Immune-deficiency Virus in Ghana is over 300,000 and unmet need for antiretroviral therapy is approximately 60%. This study sought to determine the quality of antiretroviral therapy services in selected ART sites in Ghana using the input-process-outcome approach. Methods: This is a descriptive cross-sectional case study that employed modified normative evaluation to assess quality of antiretroviral therapy services in the Oti and Volta regions of Ghana among People Living with HIV (n = 384) and healthcare providers (n = 16). The study was conducted from 11 March to 9 May 2019. Results: Resources for managing HIV clients were largely available with the exception of viral load machines, reagents for CD4 counts, and antifungals such as Fluconazole and Cotrimoxazole. Patients enrolled on antiretroviral therapy within 2 weeks was 71% and clients retained in care within 2 weeks of enrolment was 90%. Approximately 26% of enrolled clients recorded viral load suppression; 33% of People Living with HIV who were not insured with the National Health Insurance Scheme paid for some antiretrovirals and cotrimoxazole. Adherence to ART and Cotrimoxazole were 95% and 88%, respectively, using pill count on their last three visits. Time spent with clinical team was among the worst rated (mean = 2.98, standard deviation = 0.54) quality indicators by patients contrary to interpersonal relationship with health provider which was among the best rated (mean = 3.25, standard deviation = 0.41) indicators. Conclusion: Observed quality care gaps could potentially reverse gains made in HIV prevention and control in Ghana if not addressed timely; an important value addition of this study is the novel application of input-process-outcome approach in the context of antiretroviral therapy services in Ghana. There is also the need for policy dialogue on inclusion of medications for prophylaxis in antiretroviral therapy on the National Health Insurance Scheme to promote adherence and retention.

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Section: Discussionmentioning

confidence: 99%

Quality of antiretroviral therapy services in Ghana: Implications for the HIV response in resource-constrained settings

et al. 2021

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“…Because of the essential role of adherence in the success of ART, a myriad of research has been carried out to understand ART adherence. Among factors that predict HIV treatment adherence, an important role has been found in psychosocial factors such as social support [ 5 – 7 ], HIV stigma [ 6 , 8 , 9 ], stress and depression [ 7 , 10 – 14 ], violence [ 15 , 16 ] and alcohol and other drug consumption [ 17 – 19 ], which increase the probability of a disadvantageous outcome by adding substance abuse stigma [ 20 ]. Consequently, different psychosocial interventions have been developed to address treatment adherence, and they have increasingly been demonstrated to enhance HIV adherence and improve health in people living with HIV/AIDS (PLWHA) [ 10 , 11 , 19 , 21 – 26 ].…”

Section: Introductionmentioning

confidence: 99%

Internet-based peer support interventions for people living with HIV: A scoping review

et al. 2022

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Peer support interventions for people living with HIV and AIDS (PLWHA) are effective, but their associated time and material costs for the recipient and the health system make them reachable for only a small proportion of PLWHA. Internet-based interventions are an effective alternative for delivering psychosocial interventions for PLWHA as they are more accessible. Currently, no reviews are focusing on internet-based interventions with peer support components. This scoping review aims to map the existing literature on psychosocial interventions for PLWHA based on peer support and delivered through the internet. We conducted a systematic scoping review of academic literature following methodological guidelines for scoping reviews, and 28 articles met our criteria. We summarized the main characteristics of the digital peer support interventions for PLWHA and how they implemented peer support in a virtual environment. Overall the reported outcomes appeared promising, but more robust evidence is needed.

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“…non-suppression, and ongoing HIV transmission [7][8][9][10][11][12][13][14]. Integrating AOD treatment into HIV care can improve ART adherence, yet this is not typically routine practice in SA or other low-resource settings [15][16][17].…”

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confidence: 99%

Project Khanya: results from a pilot randomized type 1 hybrid effectiveness‐implementation trial of a peer‐delivered behavioural intervention for ART adherence and substance use in HIV care in South Africa

et al. 2021

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Introduction South Africa (SA) has the highest number of people living with HIV (PLWH) globally, and a significant burden of alcohol and other drug use (AOD). Although integrating AOD treatment into HIV care may improve antiretroviral therapy (ART) adherence, this is not typically routine practice in SA or other low‐resource settings. Identifying interventions that are feasible and acceptable for implementation is critical to improve HIV and AOD outcomes. Methods A pilot randomized hybrid type 1 effectiveness‐implementation trial (N = 61) was conducted to evaluate the feasibility and acceptability of Khanya, a task‐shared, peer‐delivered behavioral intervention to improve ART adherence and reduce AOD in HIV care in SA. Khanya was compared to enhanced treatment as usual (ETAU), a facilitated referral to on‐site AOD treatment. Implementation outcomes, defined by Proctor’s model, included feasibility, acceptability, appropriateness and fidelity. Primary pilot effectiveness outcomes were ART adherence at post‐treatment (three months) measured via real‐time electronic adherence monitoring, and AOD measured using biomarker and self‐report assessments over six months. Data collection was conducted from August 2018 to April 2020. Results and discussion Ninety‐one percent of participants (n = 56) were retained at six months. The intervention was highly feasible, acceptable, appropriate and delivered with fidelity (>90% of components delivered as intended by the peer). There was a significant treatment‐by‐time interaction for ART adherence (estimate = −0.287 [95% CI = −0.507, −0.066]), revealing a 6.4 percentage point increase in ART adherence in Khanya, and a 22.3 percentage point decline in ETAU. Both groups evidenced significant reductions in alcohol use measured using phosphatidylethanol (PEth) (F(2,101) = 4.16, p = 0.01), significantly decreased likelihood of self‐reported moderate or severe AOD (F(2,104) = 7.02, p = 0.001), and significant declines in alcohol use quantity on the timeline follow‐back (F(2,102) = 21.53, p < 0.001). Among individuals using drugs and alcohol, there was a greater reduction in alcohol use quantity in Khanya compared to ETAU over six months (F(2,31) = 3.28, p = 0.05). Conclusions Results of this pilot trial provide initial evidence of the feasibility and acceptability of the Khanya intervention for improving adherence in an underserved group at high risk for ongoing ART non‐adherence and HIV transmission. Implementation results suggest that peers may be a potential strategy to extend task‐sharing models for behavioral health in resource‐limited, global settings.

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Associations Between Patterns of Alcohol Use and Viral Load Suppression Amongst Women Living with HIV in South Africa

Cited by 30 publications

References 51 publications

Quality of antiretroviral therapy services in Ghana: Implications for the HIV response in resource-constrained settings

Quality of antiretroviral therapy services in Ghana: Implications for the HIV response in resource-constrained settings

Internet-based peer support interventions for people living with HIV: A scoping review

Project Khanya: results from a pilot randomized type 1 hybrid effectiveness‐implementation trial of a peer‐delivered behavioural intervention for ART adherence and substance use in HIV care in South Africa

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