Implementation of an intensive adherence intervention in patients with second-line antiretroviral therapy failure in four west African countries with little access to genotypic resistance testing: a prospective cohort study

Eholié, Serge; Moh, Raoul; Benalychérif, Aı̈da; Gabillard, Delphine; Ello, F.; Messou, Eugène; Zoungrana, Jacques; Diallo, I; Diallo, M M; Bado, Guillaume; Cissé, Mamadou; Maïga, Almoustapha Issiaka; Anzian, Amani; Toni, Thomas-d’Aquin; Congo-Ouédraogo, Malika; Touré-Kâne, Coumba; Seydi, Moussa; Minta, D.K.; Sawadogo, Adrien; Sangaré, Lassana; Drabo, Joseph; Karcher, Sophie; Carrou, Jérôme Le; Monteynard, Laure-Amélie de; Peytavin, Gilles; Gabassi, Audrey; Girard, Pierre‐Marie; Chaix, Marie‐Laure; Anglaret, Xavier; Landman, Roland

doi:10.1016/s2352-3018(19)30228-0

Cited by 16 publications

(16 citation statements)

References 28 publications

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“…A study from several countries in West Africa assessed the effectiveness of an intensive adherence counseling intervention in patients with second-line ART failure. In this study, 67% of patients (130/193) achieved viral resuppression; post study genotype resistance testing on stored samples found that the decision made based on enhanced adherence counseling alone was appropriate in 75% (145) of patients (15). Further studies are needed to help define the components of effective enhanced adherence counselling.…”

Section: Discussionmentioning

confidence: 80%

HIV viral resuppression following an elevated viral load: a systematic review and meta‐analysis

et al. 2019

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Introduction Guidelines for antiretroviral therapy recommend enhanced adherence counselling be provided to individuals with an initial elevated viral load before making a decision whether to switch antiretroviral regimen. We undertook this systematic review to estimate the proportion of patients with an initial elevated viral load who resuppress following enhanced adherence counselling. Methods Two databases and two conference abstract sites were searched from January 2012 to October 2019 for studies reporting the number of patients with an elevated viral load whose viral load was undetectable when subsequently assessed. Data were pooled using random effects meta‐analysis. Results Fifty‐eight studies reported outcomes of 45,720 viraemic patients, mostly from Africa (48 studies), and among patients on first‐line antiretroviral therapy (43 studies). Almost half (46.1%, 95% CI 42.6% to 49.5%) of patients with an initial elevated viral load resuppressed following an enhanced adherence intervention. Of those on first‐line ART with confirmed virological failure (6280 patients, 21 studies), only 53.4% (40.1% to 66.8%) were appropriately switched to a different regimen. Resuppression was higher among studies that provided details of adherence support. The proportion resuppressing was lower among children (31.2%, 21.1% to 41.3%) and adolescents (40.4%, 15.7% to 65.2%) compared to adults (50.4%, 42.6% to 58.3%). No important differences were observed by date of study publication, gender, viral failure threshold, publication status, time between viral loads or treatment regimen. Information on resistance testing among people with an elevated viral load was inconsistently reported. Conclusions The findings of this review suggest that in settings with limited resources, current guideline recommendations to provide enhanced adherence counselling can result in resuppression of a substantial number of these patients, avoiding unnecessary drug regimen changes. Appropriate action on viral load results is limited across a range of settings, highlighting the importance of viral load cascade analyses to identify gaps and focus quality improvement to ensure that action is taken on the results of viral load testing.

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Section: Discussionmentioning

confidence: 80%

HIV viral resuppression following an elevated viral load: a systematic review and meta‐analysis

et al. 2019

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“…The use of these technologies, especially when VL results are more time-sensitive (such as VL results for breast feeding women and their children, people with an initial elevated VL) would be important to enable timely clinical decision and improve treatment outcomes. As HIV treatment programs mature, the number of PLHIV on ART will continue to increase, as well as the need for VL monitoring, second-line [ 75 ] and third-line ART [ 76 ], even in settings with lack of access to drug resistance testing. These challenges need to be addressed simultaneously and systematically to ensure the long-term effectiveness and efficacy of HIV treatment in LMICs.…”

Section: Discussionmentioning

confidence: 99%

Viral load monitoring for people living with HIV in the era of test and treat: progress made and challenges ahead – a systematic review

et al. 2022

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Background In 2016, we conducted a systematic review to assess the feasibility of treatment monitoring for people living with HIV (PLHIV) receiving antiretroviral therapy (ART) in low and middle-income countries (LMICs), in line with the 90-90-90 treatment target. By 2020, global estimates suggest the 90-90-90 target, particularly the last 90, remains unattainable in many LMICs. This study aims to review the progress and identify needs for public health interventions to improve viral load monitoring and viral suppression for PLHIV in LMICs. Methods A literature search was conducted using an update of the initial search strategy developed for the 2016 review. Electronic databases (Medline and PubMed) were searched to identify relevant literature published in English between Dec 2015 and August 2021. The primary outcome was initial viral load (VL) monitoring (the proportion of PLHIV on ART and eligible for VL monitoring who received a VL test). Secondary outcomes included follow-up VL monitoring (the proportion of PLHIV who received a follow-up VL after an initial elevated VL test), confirmation of treatment failure (the proportion of PLHIV who had two consecutive elevated VL results) and switching treatment regimen rates (the proportion of PLHIV who switched treatment regimen after confirmation of treatment failure). Results The search strategy identified 1984 non-duplicate records, of which 34 studies were included in the review. Marked variations in initial VL monitoring coverage were reported across study settings/countries (range: 12–93% median: 74% IQR: 46–82%) and study populations (adults (range: 25–96%, median: 67% IQR: 50–84%), children, adolescents/young people (range: 2–94%, median: 72% IQR: 47–85%), and pregnant women (range: 32–82%, median: 57% IQR: 43–71%)). Community-based models reported higher VL monitoring (median: 85%, IQR: 82-88%) compared to decentralised care at primary health facility (median: 64%, IRQ: 48-82%). Suboptimal uptake of follow-up VL monitoring and low regimen switching rates were observed. Conclusions Substantial gaps in VL coverage across study settings and study populations were evident, with limited data availability outside of sub-Saharan Africa. Further research is needed to fill the data gaps. Development and implementation of innovative, community-based interventions are required to improve VL monitoring and address the “failure cascade” in PLHIV on ART who fail to achieve viral suppression.

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“…The intensive adherence intervention consisted of monthly counselling sessions where participants could choose any of the following reinforcement strategies: (i) direct observation of treatment by a relative, (ii) use of a pill organiser, (iii) weekly phone calls, (iv) daily alarm reminders, (v) daily SMS text messages, (vi) home visits, (vii) individual adherence counselling sessions, (viii) a peer self-help group and (ix) limiting non-ART drugs prescribed. This approach demonstrated promising outcomes with 67% of patients re-suppressed on second-line ART after 16 weeks [ 63 ].…”

Section: Methodsmentioning

confidence: 99%

A Cascade of Interventions to Promote Adherence to Antiretroviral Therapy in African Countries

et al. 2020

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Purpose of Review We reviewed interventions to improve uptake and adherence to antiretroviral therapy (ART) in African countries in the Treat All era. Recent Findings ART initiation can be improved by facilitated rapid receipt of first prescription, including community-based linkage and point-of-care strategies, integration of HIV care into antenatal care and peer support for adolescents. For people living with HIV (PLHIV) on ART, scheduled SMS reminders, ongoing intensive counselling for those with viral non-suppression and economic incentives for the most deprived show promise. Adherence clubs should be promoted, being no less effective than facility-based care for stable patients. Tracing those lost to follow-up should be targeted to those who can be seen face-to-face by a peer worker. Summary Investment is needed to promote linkage to initiating ART and for differentiated approaches to counselling for youth and for those with identified suboptimal adherence. More evidence from within Africa is needed on cost-effective strategies to identify and support PLHIV at an increased risk of non-adherence across the treatment cascade.

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Implementation of an intensive adherence intervention in patients with second-line antiretroviral therapy failure in four west African countries with little access to genotypic resistance testing: a prospective cohort study

Cited by 16 publications

References 28 publications

HIV viral resuppression following an elevated viral load: a systematic review and meta‐analysis

HIV viral resuppression following an elevated viral load: a systematic review and meta‐analysis

Viral load monitoring for people living with HIV in the era of test and treat: progress made and challenges ahead – a systematic review

A Cascade of Interventions to Promote Adherence to Antiretroviral Therapy in African Countries

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