High rates of retention and viral suppression in the scale‐up of antiretroviral therapy adherence clubs in Cape Town, South Africa

Tsondai, Priscilla R; Wilkinson, Lynne; Grimsrud, Anna; Mdlalo, Precious Thembekile; Ullauri, Angelica; Boulle, Andrew

doi:10.7448/ias.20.5.21649

Cited by 103 publications

(151 citation statements)

References 25 publications

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“…Simpler models of PrEP delivery are being evaluated, including community‐based refills and use of self‐testing for HIV to expedite visits. Adherence clubs are being evaluated as a strategy to support PrEP persistence, similar to the model of community ART clubs have been demonstrated to be very acceptable and improve ART persistence and adherence among those living with HIV .…”

Section: Discussionmentioning

confidence: 99%

“…Simpler models of PrEP delivery are being evaluated, including community-based refills and use of self-testing for HIV to expedite visits. Adherence clubs are being evaluated as a strategy to support PrEP persistence, similar to the model of community ART clubs have been demonstrated to be very acceptable and improve ART persistence and adherence among those living with HIV [72]. An important tension with simple, parsimonious PrEP delivery for African AGYW is that they have high rates of depression, IPV, and STIs, and ideally PrEP programmes should include wrap-around services for mental health and STIs.…”

Section: Discussionmentioning

confidence: 99%

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HIV pre‐exposure prophylaxis for adolescent girls and young women in Africa: from efficacy trials to delivery

et al. 2019

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Introduction Adolescent girls and young women (AGYW) in Africa have high HIV incidence despite scale‐up of HIV testing and HIV treatment. Placebo‐controlled trials of tenofovir‐based pre‐exposure prophylaxi (PrEP) in diverse populations demonstrated that PrEP works with close to 100% effectiveness if taken with high, but not perfect, adherence. Divergent efficacy estimates among African AGYW led to demonstration and implementation projects to better understand motivations for HIV prevention, uptake, adherence and persistence to PrEP. To inform PrEP programmes, the design and initial findings from PrEP demonstration projects for AGYW are reviewed. Discussion Early lessons from PrEP implementation projects among young African women include: (1) awareness and demand creation with positive messaging about the benefits of PrEP are critical to motivate AGYW to consider this novel prevention technology and to foster awareness among peers, partners, parents and guardians to support AGYW's effective PrEP use; (2) PrEP initiation is high in projects that are integrating PrEP into youth‐friendly clinics, family planning clinics and mobile clinics; (3) young African women at risk are initiating PrEP, based on behavioural characteristics, history of intimate partner violence, depression and 30% prevalence of chlamydia and/or gonorrhoea; (4) provision of youth‐friendly PrEP delivery programmes that integrate reproductive health services, including contraception and the diagnosis and treatment of sexually transmitted infections, increase health impact; (5) messages that emphasize the necessity for high adherence while at potential risk of HIV exposure and support strategies that addresses AGYW's adherence challenges are essential; and, (6) a substantial proportion of AGYW do not persist with PrEP, and strategies are needed to help AGYW assess their ongoing need, motivation and challenges with persisting with PrEP. Conclusions PrEP is feasible to implement in integrated reproductive health service delivery models to reach African AGYW. While PrEP demonstration projects indicate that women with behavioural risks and high rates of sexually transmitted diseases are initiating PrEP; effective strategies to support AGYW's adherence and persistence with PrEP are needed. Lessons learned from oral PrEP delivery, a novel first generation HIV prevention product, are relevant to longer‐acting and less adherence‐dependent strategies which are currently in clinical trials.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

HIV pre‐exposure prophylaxis for adolescent girls and young women in Africa: from efficacy trials to delivery

et al. 2019

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“…Some barriers to adherence and viral suppression may be common to both individuals, and a family‐centred management approach, rather than an individual approach, may be needed to address these barriers effectively. Differentiated care models that focus on the needs of families living with HIV are emerging . In South Africa, family clubs are being used as ART distribution alternatives .…”

Section: Discussionmentioning

confidence: 99%

“…Differentiated care models that focus on the needs of families living with HIV are emerging . In South Africa, family clubs are being used as ART distribution alternatives . In Uganda, implementing weekly clinics where children and adolescents were treated together with their families improved appointment adherence, and similar models have been implemented in urban centres in Kenya and through community groups in Namibia .…”

Section: Discussionmentioning

confidence: 99%

“…In Uganda, implementing weekly clinics where children and adolescents were treated together with their families improved appointment adherence, and similar models have been implemented in urban centres in Kenya and through community groups in Namibia . These care models may offer services that are better tailored to family issues and more efficient for programmes and patients . To date, however, existing models have focused on clinically stable families and children with reliable caregivers, and knowledge gaps exist regarding models for at‐risk families .…”

Section: Discussionmentioning

confidence: 99%

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Viral suppression among children and their caregivers living with HIV in western Kenya

et al. 2019

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Introduction Despite the central role of caregivers in managing HIV treatment for children living with HIV , viral suppression within caregiver–child dyads in which both members are living with HIV is not well described. Methods We conducted a retrospective analysis of children living with HIV <15 years of age and their caregivers living with HIV attending HIV clinics affiliated with the Academic Model Providing Access to Healthcare ( AMPATH ) in Kenya between 2015 and 2017. To be included in the analysis, children and caregivers must have had ≥1 viral load ( VL ) during the study period while receiving antiretroviral therapy ( ART ) for ≥6 months, and the date of the caregiver's VL must have occurred ±90 days from the date of the child's VL . The characteristics of children, caregivers and dyads were descriptively summarized. Multivariable logistic regression was used to estimate the odds of viral non‐suppression (≥ 1000 copies/ mL ) in children, adjusting for caregiver and child characteristics. Results Of 7667 children who received care at AMPATH during the study period, 1698 were linked to a caregiver living with HIV and included as caregiver–child dyads. For caregivers, 94% were mothers, median age at ART initiation 32.8 years, median CD 4 count at ART initiation 164 cells/mm 3 and 23% were not virally suppressed. For children, 52% were female, median age at ART initiation 4.2 years, median CD 4 values at ART initiation were 15% (age < 5 years) and 396 cells/mm 3 (age ≥ 5 years), and 38% were not virally suppressed. In the multivariable model, children were found more likely to not be virally suppressed if their caregivers were not suppressed compared to children with suppressed caregivers ( aOR = 2.40, 95% CI : 1.86 to 3.10). Other characteristics associated with child viral non‐suppression included caregiver ART regimen change prior to the VL , caregiver receipt of a non‐ NNRTI ‐based regimen at the time of the VL , younger child age at ART initiation and child tuberculosis treatment at the time of the VL . Conclusions Children were at higher risk of viral non‐suppression if their caregive...

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“My future is bright…I won't die with the cause of AIDS”: ten‐year patient ART outcomes and experiences in South Africa

et al. 2018

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IntroductionSouth Africa is moving into a new era of HIV treatment with “treat all” policies where people may be on treatment for most of their lives. We need to understand treatment outcomes and facilitators of long‐term antiretroviral treatment (ART) adherence and retention‐in‐care in the South African context. In one of the first studies to investigate long‐term treatment outcomes in South Africa, we aimed to describe ten‐year patient outcomes at a large public‐sector HIV clinic in Johannesburg and explore patient experiences of the treatment programme over this time in order to ascertain factors that may aid or hinder long‐term adherence and retention.MethodsWe conducted a cohort analysis (n = 6644) and in‐depth interviews (n = 24) among HIV‐positive adults initiating first‐line ART between April 2004 and March 2007. Using clinical records, we ascertained twelve‐month and ten‐year all‐cause mortality and loss to follow‐up (LTF). Cox proportional hazards regression was used to identify baseline predictors of attrition (mortality and LTF (>3 months late for the last scheduled visit)) at twelve months and ten years. Twenty‐four patients were purposively selected and interviewed to explore treatment programme experiences over ten years on ART.ResultsExcluding transfers, 79.5% (95% confidence intervals (CI): 78.5 to 80.5) of the cohort were alive, in care at twelve months dropping to 35.1% (95% CI: 33.7 to 36.4) at ten years. Over 44% of deaths occurred within 12 months. Ten‐year all‐cause mortality increased, while LTF decreased slightly, with age. Year and age at ART initiation, sex, nationality, baseline CD4 count, anaemia, body mass index and initiating regimen were predictors of ten‐year attrition. Among patients interviewed, the pretreatment clinic environment, feelings of gratitude and good fortune, support networks, and self‐efficacy were facilitators of care; side effects, travel and worsening clinical conditions were barriers. Participants were generally optimistic about their futures and were committed to continued care.ConclusionsThis study demonstrates the complexities of long‐term chronic HIV treatment with declining all‐cause mortality and increasing LTF over ten years. Barriers to long‐term retention still present a significant challenge. As more people become eligible for ART in South Africa under “treatment for all,” new healthcare delivery challenges will arise; interventions are needed to ensure long‐term programme successes continue.

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High rates of retention and viral suppression in the scale‐up of antiretroviral therapy adherence clubs in Cape Town, South Africa

Cited by 103 publications

References 25 publications

HIV pre‐exposure prophylaxis for adolescent girls and young women in Africa: from efficacy trials to delivery

HIV pre‐exposure prophylaxis for adolescent girls and young women in Africa: from efficacy trials to delivery

Viral suppression among children and their caregivers living with HIV in western Kenya

“My future is bright…I won't die with the cause of AIDS”: ten‐year patient ART outcomes and experiences in South Africa

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