Sinako, a study on HIV competent households in South Africa: a cluster-randomised controlled trial protocol

Abstract

Background: With 7.7 million South Africans currently infected with human immunodeficiency virus (HIV) and 4.8 million currently receiving antiretroviral treatment (ART), the epidemic represents a considerable burden for the country's resource-limited health system. In response to the health and human resource shortages, task shifting to community health workers (CHWs) and empowering people living with HIV (PLWH) are integral parts of a sustainable ART strategy. Despite the success of the ART programme, South Africa still faces both prevention and treatment challenges. To tackle these challenges, future endeavours need to focus on the role played by the households of PLWH in mediating between the community and PLWH themselves. Building health-enabling "HIV competent" households with the capacity to actively stimulate lifestyles that foster health, offers a potential strategy to tackle South Africa's HIV-related challenges. The aim of the "Sinako: Households and HIV" study is to investigate to what extent and how an intervention can increase HIV competence in PLWH and their households, and subsequently optimise the impact of CHW support on individual ART outcomes. Methods: The "Sinako" study is a cluster-randomised controlled trial with two arms. In the control arm, CHWs offer a standard package of support to PLWH during home visits, focused on the individual. The intervention arm includes both a focus on the individual and the household to enable the patient to self-manage their treatment within an HIV competent household. A longitudinal mixed methods design is adopted to analyse the data. For the quantitative data analysis, methods including latent cross-lagged modelling, multilevel modelling and logistic regression will be used. To assess the acceptability and feasibility of the intervention and to construct a comprehensive picture of the mechanisms underlying the impact on the household and the PLWH, qualitative data (in-depth interviews and focus group discussions) will be collected and analysed. Discussion: Stimulating HIV competence in households could be a feasible and sustainable strategy to optimise the outcomes of CHW interventions and thus be important for HIV treatment interventions in resource-limited settings.

Stay-at-Home: The Impact of the COVID-19 Lockdown on Household Functioning and ART Adherence for People Living with HIV in Three Sub-districts of Cape Town, South Africa

“…Community health workers (CHWs), who deliver the intervention, are linked to health facilities: twelve facilities were therefore randomly selected, resulting in six facilities per trial arm. The trial protocol is detailed elsewhere [ 31 ].…”

“…The intervention consists of seven hour-long sessions with trial participants and, if the participant agrees, a household member. The household was defined as including all those people who ‘eat from the same pot’ for at least four nights per week over the last month [ 31 ]. The intervention sessions cover a variety of topics from adherence planning to developing household HIV competency.…”

“…Public health approaches to ART adherence increasingly recognize the role that the immediate environment, and especially the household, play in creating health-enabling environments [ 31 – 36 ]. Masquillier et al posit that when household members enact behaviours supporting HIV prevention, discussion and disclosure, this ‘household HIV competency’ has positive effects on ART adherence for PLWH [ 32 ].…”

Households in HIV Care: Designing an Intervention to Stimulate HIV Competency in Households in South Africa

“…This intervention development process is part of a larger project -the "Sinako-HIV and Households" study (24). As part of this parent project, a cluster-randomized control trial will test the intervention developed in this paper.…”

Adapting to, integrating and self-managing HIV as a chronic illness: a scoping review protocol

“…This scoping review forms an initial stage of a multiphase doctoral research study and is also part of the Sinako cluster randomised control study, for which ethics approval has been obtained. 65 Results of the proposed review will be published in a peer-reviewed journal and presented at related scientific events.…”