Improved Survival and Antiretroviral Treatment Outcomes in Adults Receiving Community-Based Adherence Support

Fatti, Geoffrey; Meintjes, Graeme; Shea, Jawaya; Eley, Brian; Grimwood, Ashraf

doi:10.1097/qai.0b013e31826a6aee

Cited by 90 publications

(103 citation statements)

References 41 publications

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“…[24] The results of our study suggest that programmes to reduce adolescent pregnancies, expanded adolescent HIV counselling and testing programmes (including implementation of the Integrated School Health Programme), early detection of young women who seroconvert during pregnancy, and transforming reproductive health services to be more youth and adolescent friendly [9,10] may also lead to reduced MTCT. Early identification of young pregnant women who are HIV positive, swift initiation of triple ART and providing youthcentred ART adherence support to these women need to be important priorities for prevention of MTCT programmes.…”

Section: Discussionmentioning

confidence: 99%

“…[10] The facilities were supported by Kheth'Impilo, a nonprofit organisation that supports the SA Department of Health. Kheth'Impilo has supported direct HIV service delivery by providing clinical staff and community based adherence support, [10] and now includes supporting general health system strengthening and technical assistance emphasising quality improvement, human resource development, supply chain management and monitoring and evaluation. + cell counts ≤200 cells/µL or in World Health Organization (WHO) clinical stage IV were eligible to start lifelong triple antiretroviral therapy (ART).…”

Section: Study Design Setting and Inclusion Criteriamentioning

confidence: 99%

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Adolescent and young pregnant women at increased risk of mother-to-child transmission of HIV and poorer maternal and infant health outcomes: A cohort study at public facilities in the Nelson Mandela Bay Metropolitan district, Eastern Cape, South Africa

et al. 2014

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Background. South Africa (SA) has the highest burden of childhood HIV infection globally, and has high rates of adolescent and youth pregnancy. Objective. To explore risks associated with pregnancy in young HIVinfected women, we compared mothertochild transmission (MTCT) of HIV and maternal and infant health outcomes according to maternal age categories. Methods. A cohort of HIVpositive pregnant women and their infants were followed up at three sentinel surveillance facilities in the Nelson Mandela Bay Metropolitan (NMBM) district, Eastern Cape Province, SA. Young women were defined as ≤24 years old and adolescents as ≤19 years. The effect of younger maternal age categories on MTCT and maternal and child health outcomes was assessed using logbinomial and Cox regression controlling for confounding, using women aged >24 years as the comparison group. Results. Of 956 mothers, 312 (32.6%) were young women; of these, 65 (20.8%) were adolescents. The proportion of young pregnant women increased by 24% between 2009/10 and 2011/12 (from 28.3% to 35.1%). Young women had an increased risk of being unaware of their HIV status when booking (adjusted risk ratio (aRR) 1.37; 95% confidence interval (CI) 1.21 1.54), a reduced rate of antenatal antiretroviral therapy (ART) uptake (adjusted hazard ratio 0.46; 95% CI 0.31 0.67), reduced early infant HIV diagnosis (aRR 0.94; 95% CI 0.94 0.94), and increased MTCT (aRR 3.07; 95% CI 1.18 7.96; adjusted for ART use). Of all vertical transmissions, 56% occurred among young women. Additionally, adolescents had increased risks of first presentation during labour (aRR 3.78; 95% CI 1.06 13.4); maternal mortality (aRR 35.1; 95% CI 2.89 426) and stillbirth (aRR 3.33; 95% CI 1.53 7.25).Conclusion. An increasing proportion of pregnant HIVpositive women in NMBM were young, and they had increased MTCT and poorer maternal and infant outcomes than older women. Interventions targeting young women are increasingly needed to reduce pregnancy, HIV infection and MTCT and improve maternal and infant outcomes if SA is to attain its Millennium Development Goals.

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Section: Discussionmentioning

confidence: 99%

Section: Study Design Setting and Inclusion Criteriamentioning

confidence: 99%

Adolescent and young pregnant women at increased risk of mother-to-child transmission of HIV and poorer maternal and infant health outcomes: A cohort study at public facilities in the Nelson Mandela Bay Metropolitan district, Eastern Cape, South Africa

et al. 2014

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“…Community-based adherence support (CBAS) programmes have been shown to improve virological outcomes and programme retention amongst adults receiving ART (Fatti, Meintjes, Shea, Eley, & Grimwood, 2012;Igumbor, Scheepers, Ebrahim, Jason, & Grimwood, 2011), and improves retention in children receiving ART . However, little data on the effectiveness of community adherence support on virological outcomes in children on ART is available.…”

Section: Please Scroll Down For Articlementioning

confidence: 99%

Improved virological suppression in children on antiretroviral treatment receiving community-based adherence support: A multicentre cohort study from South Africa

et al. 2013

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Adherence to antiretroviral treatment (ART) is a challenge in childhood, and children on ART have reduced virological suppression compared to adults. This study evaluated the effect of community-based adherence support (CBAS) on virological outcomes amongst children receiving ART in four South African provinces. Patient Advocates are lay CBAS workers who provide adherence and psychosocial support for patients, undertaking home visits to address household challenges affecting adherence. Patient Advocates provide counselling for children's carers regarding adherence and psychosocial problems. A multicentre cohort study using routinely collected data was conducted at 57 public ART sites including ART-naive children (<16 years) starting ART. Virological suppression until four years of ART was compared between children who received and did not receive CBAS. Analyses were by intention-to-treat, controlling for confounding using multivariable generalised estimating equations. A total of 4853 children were included, of whom 982 (20.2%) received CBAS. The median baseline age was 6.3 years and the baseline CD4 cell percentage was 12.0%; both were equivalent between the two groups. CBAS children had more advanced baseline clinical disease (62.1% vs. 52.6% World Health Organisation stages III or IV; P < 0.0001). A total of 5908 viral load results were analysed. Virological suppression was 65.6% (95% confidence interval [CI]: 62.7-68.4%) vs. 55.5% (95% CI: 54.1-57.0%) in CBAS and non-CBAS children, respectively, at any time-point on treatment (P < 0.0001). In analyses controlling for baseline clinical, demographic, site-related variables and time on ART, children receiving CBAS were more likely to achieve virological suppression, adjusted odds ratio (aOR) 1.60 (95% CI: 1.35-1.89; P < 0.0001). The effect of CBAS increased in magnitude with increasing durations of ART, and CBAS particularly improved virological suppression in a higher-risk subgroup (children younger than two years, aOR 2.47 [95% CI: 1.59-3.84]). CBAS was associated with improved virological suppression in children receiving ART. Expanded implementation of this low-cost intervention should be considered in resource-poor settings.

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“…Levels of ARV adherence in South Africa have generally been found to be high (that is, above 90 %) [4][5][6]. However adherence fluctuates over time [7], and sustained efforts to maintain high levels of long-term adherence are necessary [8].…”

Section: Introductionmentioning

confidence: 99%

From Research to Practice: Lay Adherence Counsellors’ Fidelity to an Evidence-Based Intervention for Promoting Adherence to Antiretroviral Treatment in the Western Cape, South Africa

et al. 2013

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In the Western Cape, lay counsellors are tasked with supporting antiretroviral (ARV) adherence in public healthcare clinics. Thirty-nine counsellors in 21 Cape Town clinics were trained in Options for Health (Options), an evidence-based intervention based on motivational interviewing (MI). We evaluated counsellors' ability to deliver Options for addressing poor adherence following 5 days training. Audio-recordings of counselling sessions collected following training were transcribed and translated into English. Thirtyfive transcripts of sessions conducted by 35 counsellors were analysed for fidelity to the Options protocol, and using the Motivational Interviewing Treatment and Integrity (MITI) code. Counsellors struggled with some of the strategies associated with MI, such as assessing readiness-to-change and facilitating change talk. Overall, counsellors failed to achieve proficiency in the approach of MI according to the MITI. Counsellors were able to negotiate realistic plans for addressing patients' barriers to adherence. Further efforts aimed at strengthening the ARV adherence counselling programme are needed.

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Improved Survival and Antiretroviral Treatment Outcomes in Adults Receiving Community-Based Adherence Support

Abstract: Patients receiving CBAS had considerably better ART outcomes. Further scale-up of these programs should be considered in low-income settings.

Cited by 90 publications

References 41 publications

Adolescent and young pregnant women at increased risk of mother-to-child transmission of HIV and poorer maternal and infant health outcomes: A cohort study at public facilities in the Nelson Mandela Bay Metropolitan district, Eastern Cape, South Africa

Adolescent and young pregnant women at increased risk of mother-to-child transmission of HIV and poorer maternal and infant health outcomes: A cohort study at public facilities in the Nelson Mandela Bay Metropolitan district, Eastern Cape, South Africa

Improved virological suppression in children on antiretroviral treatment receiving community-based adherence support: A multicentre cohort study from South Africa

From Research to Practice: Lay Adherence Counsellors’ Fidelity to an Evidence-Based Intervention for Promoting Adherence to Antiretroviral Treatment in the Western Cape, South Africa

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