Intensive adherence counselling for HIV‐infected individuals failing second‐line antiretroviral therapy in Johannesburg, South Africa

Fox, Matthew P.; Berhanu, Rebecca; Steegen, Kim; Firnhaber, Cindy; Ive, Prudence; Spencer, David; Mashamaite, Sello; Sheik, Sadiyya; Jonker, Ingrid; Howell, Pauline; Long, Lawrence; Evans, Denise

doi:10.1111/tmi.12741

Cited by 53 publications

(58 citation statements)

References 21 publications

(24 reference statements)

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“…Further, our results show it is difficult to get patients to return to care and to ensure they are retested within the 3 month period to determine EAC success. While we have previously found such a targeted approach can be successful for patients with elevated viral loads [37], without a randomised design it has been hard to argue these associations are causal and these findings suggest they may not be. We do note that delays in viral load testing may have an influence on resuppression given that resistance can develop quickly with NNRTI-based regimens like those being used in South Africa.…”

Section: Discussionmentioning

confidence: 88%

Effectiveness of interventions for unstable patients on antiretroviral therapy in South Africa: results of a cluster‐randomised evaluation

Fox

Pascoe

Huber

et al. 2018

Tropical Med Int Health

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Background As loss from HIV care is an ongoing challenge globally, interventions are needed for patients who don't achieve or maintain ART stability. The 2015 South African National Adherence Guidelines (AGL) for Chronic Diseases include two interventions targeted at unstable patients: early tracing of patients who miss visits (TRIC) and enhanced adherence counselling (EAC). Methods As part of a cluster‐randomised evaluation at 12 intervention and 12 control clinics in four provinces, intervention sites implemented the AGL interventions, while control sites retained standard care. We report on outcomes of EAC for patients with an elevated viral load (>400 copies/ml) and for TRIC patients who missed a visit by >5 days. We estimated risk differences (RD) of 3 and 12‐month viral resuppression (<400 copies/ml) and 12‐month retention with cluster adjustment using generalised estimating equations and controlled for imbalances using difference‐in‐differences compared to all eligible in 2015, prior to intervention roll‐out. Results For EAC, we had 358 intervention and 505 control site patients (61% female, median ART initiation CD4 count 154 cells/μl). We found no difference between arms in 3‐month resuppression (RD: −1.7%; 95%CI: −4.3% to 0.9%), but <20% of patients had a repeat viral load within 3 months (19.8% intervention, 13.5% control). Including the entire clinic population eligible for EAC with a repeat viral load at all evaluation sites (n = 934), intervention sites showed a small increase in 3‐month resuppression (28% vs. 25%, RD 3.0%; 95%CI: −2.7% to 8.8%). Adjusting for baseline differences increased the RD to 8.1% (95% CI: −0.1% to 17.2%). However, we found no differences in 12‐month suppression (RD: 1.5%; 95% CI: −14.1% to 17.1% but suppression was low overall at 40%) or retention (RD: 2.8%; 95% CI: −7.5% to 13.2%). For TRIC, we enrolled 155 at intervention sites and 248 at control sites (44% >40 years, 67% female, median CD4 count 212 cells/μl). We found no difference between groups in return to care by 12 months (RD: −6.8%; 95% CI: −17.7% to 4.8%). During the study period, control sites continued to use tracing within standard care, however, potentially masking intervention effects. Conclusions Enhanced adherence counselling showed no benefit over 12 months. Implementation of the tracing intervention under the new guidelines was similar to the standard of care. Interventions that aim to return unstable patients to care should incorporate active monitoring to determine if the interventions are effective.

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Section: Discussionmentioning

confidence: 88%

Effectiveness of interventions for unstable patients on antiretroviral therapy in South Africa: results of a cluster‐randomised evaluation

Fox

Pascoe

Huber

et al. 2018

Tropical Med Int Health

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“…This evidence provides an opportunity for engaging patients from treatment initiation by providing additional support and counselling to ensure that they remain engaged throughout their treatment span. [35] Support and counselling benefits have been reported in firstline treatment cohorts where similar retention-in-care patterns were identified. [35,36] Mberi et al [36] described a group receiving care from 2002 to 2012 at a high-volume SA ART clinic.…”

Section: Researchmentioning

confidence: 82%

“…[35] Support and counselling benefits have been reported in firstline treatment cohorts where similar retention-in-care patterns were identified. [35,36] Mberi et al [36] described a group receiving care from 2002 to 2012 at a high-volume SA ART clinic. They reported 40% of the patients being LTFU within 12 months of starting ART, a slight subsequent decrease in retention, a sharp decline from year 5, and plateauing at year 8.…”

Section: Researchmentioning

confidence: 82%

Descriptive analysis of World Health Organization-recommended second-line antiretroviral treatment: A retrospective cohort data analysis

et al. 2019

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“…In other words, without DRT, more than 60% of patients with VF included would have been unnecessarily switched to third‐line ART. Recent studies also reported a significant proportion of second‐line failure without major resistance to the current regimen and poor adherence was indicated as a major factor underlying VF .…”

Section: Discussionmentioning

confidence: 99%

HIV‐1 drug resistance testing at second‐line regimen failure in Arua, Uganda: avoiding unnecessary switch to an empiric third‐line

Fily

Ayikobua

Ssemwanga

et al. 2018

Tropical Med Int Health

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Intensive adherence counselling for HIV‐infected individuals failing second‐line antiretroviral therapy in Johannesburg, South Africa

Abstract: Most (64%) second-line treatment failure in this clinic is related to adherence and can be overcome with careful adherence support. Controlled interventions are needed to determine what the optimal approach is to improving second-line outcomes and reducing the need for third-line ART.

Cited by 53 publications

References 21 publications

Effectiveness of interventions for unstable patients on antiretroviral therapy in South Africa: results of a cluster‐randomised evaluation

Effectiveness of interventions for unstable patients on antiretroviral therapy in South Africa: results of a cluster‐randomised evaluation

Descriptive analysis of World Health Organization-recommended second-line antiretroviral treatment: A retrospective cohort data analysis

HIV‐1 drug resistance testing at second‐line regimen failure in Arua, Uganda: avoiding unnecessary switch to an empiric third‐line

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