PEBRA trial – effect of a peer-educator coordinated preference-based ART service delivery model on viral suppression among adolescents and young adults living with HIV: protocol of a cluster-randomized clinical trial in rural Lesotho

Lejone, Thabo Ishmael; Kopo, Mathebe; Bachmann, Nadine; Brown, Jennifer Anne; Glass, Tracy R.; Muhairwe, Josephine; Matsela, Tebatso; Scherrer, Ramona; Chere, Lebohang; Namane, Tilo; Labhardt, Niklaus Daniel; Amstutz, Alain

doi:10.1186/s12889-020-08535-6

Cited by 9 publications

(17 citation statements)

References 15 publications

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“…Consequently, community-based peer support interventions for children, young people and ALHIV have not provided consistent evidence of effectiveness, fueling the debate around applicability of DSD models for adolescents [ 33 ]. Barriers in the adolescent HIV care continuum are multifactorial, thus DSD models consisting of multicomponent packages may have the greatest potential to address the multiple and unique needs of adolescents [ 38 ]. However, some key considerations must be made in tailoring services to different populations.…”

Section: Discussionmentioning

confidence: 99%

Interventions to Improve Treatment Outcomes among Adolescents on Antiretroviral Therapy with Unsuppressed Viral Loads: A Systematic Review

Munyayi

Wyk

Mayman

2022

IJERPH

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Adolescents living with HIV (ALHIV) face unique developmental challenges that increase the risk of unsuppressed viral loads. Current reviews present a need for proven interventions to improve viral suppression among ALHIV on ART, who have a history of unsuppressed viral loads. This systematic review aims to synthesize and appraise evidence of the effectiveness of interventions to improve treatment outcomes among ALHIV with unsuppressed viral loads. Six bibliographic databases were searched for published studies and gray literature from 2010 to 2021. The risk of bias and certainty of evidence was assessed using the ROBINS-I tool, CASP checklists and GRADE. A total of 28 studies were eligible for full-text screening; and only three were included in the qualitative synthesis. In addition, two studies were included from website searches. Four types of interventions to improve viral suppression were identified, namely: intensive adherence counselling; community- and facility-based peer-led differentiated service delivery (DSD); family based economic empowerment; and conditional economic incentives and motivational interviewing. We strongly recommend peer-led community-based DSD interventions, intensive adherence counselling, and family-based economic empowerment as potential interventions to improve viral suppression among ALHIV.

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Section: Discussionmentioning

confidence: 99%

Interventions to Improve Treatment Outcomes among Adolescents on Antiretroviral Therapy with Unsuppressed Viral Loads: A Systematic Review

Munyayi

Wyk

Mayman

2022

IJERPH

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“…A total of 32 clinical trial protocols met the selection criteria. Of these, 44% (14/32) [ [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] ]were informed by a pilot/feasibility study while the majority [56% (18/32)] [ [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] ] were not informed by a pilot/feasibility study ( Fig. 2 ).…”

Section: Resultsmentioning

confidence: 99%

The practice of pilot/feasibility studies in informing the conduct of HIV related clinical trials in sub-Saharan Africa: A scoping review

Nalubega

Osuwat

Agyeiwaa

et al. 2022

Contemporary Clinical Trials Communications

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“…In this study, we only included data of the 123 of the 150 participants at the 10 PEBRA model clinics who remained in care over the entire 12-month period. Detailed information about the setting, design, eligibility, randomization, data collection and management as well as about the primary and secondary endpoint are published in the PEBRA study protocol [13] and the main results are under review in a peer-reviewed journal (cite PEBRA).…”

Section: Methodsmentioning

confidence: 99%

“…In this secondary analysis, we used data collected in the intervention arm of the PEBRA (Peer educator Based Refill of ART) cluster randomized trial in rural Lesotho [13]. We evaluated participants’ HIV care preferences, their feasibility, and intra-individual changes of preferences throughout the 12-month study period.…”

Section: Introductionmentioning

confidence: 99%

HIV care preferences among young people living with HIV in Lesotho: A secondary data analysis of the PEBRA cluster randomized trial

Seiler

Kopo²,

Kao³

et al. 2022

Preprint

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Sub-Saharan Africa is home to 89% of all young people living with HIV, a key population with specific challenges and needs. In-depth knowledge of service demands is needed to tailor and differentiate service delivery for this group. We evaluated HIV care preferences among young people living with HIV who were part of the PEBRA (Peer Educator Based Refill of ART) cluster-randomized trial. The PEBRA trial evaluated a novel model of care at 20 health facilities in Lesotho, Southern Africa. In the PEBRA model, a peer educator regularly assessed participant preferences regarding antiretroviral therapy (ART) refill location, SMS notifications (for adherence, drug refill, viral load) and general care support options, and delivered services accordingly over a 12-month period. We present these preferences, their changes over time and how often it was not feasible to deliver them. At enrolment, 41 of 123 (33.3%) chose ART refill outside the health facility, compared to 8 of 123 (6.5%) after 12 months. Among those selecting clinic-based ART refill, many collected ART during the peer educator led Saturday clinic club, 45 of 123 (36.5%) at the beginning and 55 of 123 (44.7%) at the end. SMS reminder for adherence and/or ART refill was chosen by 51 of 123 (41.5%) at enrolment and 54 of 123 (44.7%) at the last assessment. Support by the peer educator was popular at the beginning (110 of 123 (89.4%)) and lower but still high at the end (85 of 123 (69.1%)). 13 of 123 (10.6%) participants chose support by the nurse only at the first and 21 of 123 (17.1%) at the last assessment. The overarching trial was prospectively registered on ClinicalTrials.gov ( NCT03969030 ). Our longitudinal preference assessment among young people living with HIV showed a sustained interest in SMS notifications for adherence and refill visits as well as in additional support by a peer educator. ART refill outside the health facility was not as popular as expected; instead, medication pick-up at the facility, especially during Saturday clinic clubs, was favoured.

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PEBRA trial – effect of a peer-educator coordinated preference-based ART service delivery model on viral suppression among adolescents and young adults living with HIV: protocol of a cluster-randomized clinical trial in rural Lesotho

Cited by 9 publications

References 15 publications

Interventions to Improve Treatment Outcomes among Adolescents on Antiretroviral Therapy with Unsuppressed Viral Loads: A Systematic Review

Interventions to Improve Treatment Outcomes among Adolescents on Antiretroviral Therapy with Unsuppressed Viral Loads: A Systematic Review

The practice of pilot/feasibility studies in informing the conduct of HIV related clinical trials in sub-Saharan Africa: A scoping review

HIV care preferences among young people living with HIV in Lesotho: A secondary data analysis of the PEBRA cluster randomized trial

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