Supportive interventions to improve retention on ART in people with HIV in low- and middle-income countries: A systematic review

Penn, Amy; Azman, Hana; Horváth, Hacsi; Taylor, Kelly D.; Hickey, Matthew D.; Rajan, Jay; Negussie, Eyerusalem; Doherty, Margaret; Rutherford, George W.

doi:10.1371/journal.pone.0208814

Cited by 35 publications

(31 citation statements)

References 30 publications

(91 reference statements)

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“…Our analysis on potential risk factors for mortality does not identify any key associated factor. However, published data show lower mortality with increasing number of family members living in the same household, as suggested previously by the fact that family members' awareness of TB and HIV symptoms, treatment and care could also deal with complex stigma and discrimination perceptions 30 , 31 , making family support a positive influence in seeking health care access 32 , 33 .…”

Section: Discussionsupporting

confidence: 58%

Mortality and risk of tuberculosis among people living with HIV in whom TB was initially ruled out

García

Mambuque

Nguenha

et al. 2020

Sci Rep

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Tuberculosis (TB) misdiagnosis remains a public health concern, especially among people living with HIV (PLHIV), given the high mortality associated with missed TB diagnoses. The main objective of this study was to describe the all-cause mortality, TB incidence rates and their associated risk factors in a cohort of PLHIV with presumptive TB in whom TB was initially ruled out. We retrospectively followed a cohort of PLHIV with presumptive TB over a 2 year-period in a rural district in Southern Mozambique. During the study period 382 PLHIV were followed-up. Mortality rate was 6.8/100 person-years (PYs) (95% CI 5.2–9.2) and TB incidence rate was 5.4/100 PYs (95% CI 3.9–7.5). Thirty-six percent of deaths and 43% of TB incident cases occurred in the first 12 months of the follow up. Mortality and TB incidence rates in the 2-year period after TB was initially ruled out was very high. The TB diagnostic work-up and linkage to HIV care should be strengthened to decrease TB burden and all-cause mortality among PLHIV with presumptive TB.

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Section: Discussionsupporting

confidence: 58%

Mortality and risk of tuberculosis among people living with HIV in whom TB was initially ruled out

García

Mambuque

Nguenha

et al. 2020

Sci Rep

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“…Peer counseling, adherence clubs, and mobile text messaging and reminder devices are recommended by current guidelines to support adherence and retention in care [4]. Reasons for suboptimal adherence are multiple and similar to reasons for disengagement from care, and some supportive interventions address both issues [39,40], suggesting that for future guidance interventions to support adherence, retention, and reengagement in care could be considered together as a single package.…”

Section: Integrating Support For Adherence and Retention In Carementioning

confidence: 99%

Emerging priorities for HIV service delivery

Ford

Geng²,

Ellman

et al. 2020

PLoS Med

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“…A broad range of supportive interventions may improve retention (e.g. community‐based adherence support, health technology interventions) , potentially also under Treat‐All .…”

Section: Discussionmentioning

confidence: 99%

HIV programmatic outcomes following implementation of the ‘Treat‐All’ policy in a public sector setting in Eswatini: a prospective cohort study

et al. 2020

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Introduction The Treat‐All policy – antiretroviral therapy (ART) initiation irrespective of CD4 cell criteria – increases access to treatment. Many ART programmes, however, reported increasing attrition and viral failure during treatment expansion, questioning the programmatic feasibility of Treat‐All in resource‐limited settings. We aimed to describe and compare programmatic outcomes between Treat‐All and standard of care (SOC) in the public sectors of Eswatini. Methods This is a prospective cohort study of ≥16‐year‐old HIV‐positive patients initiated on first‐line ART under Treat‐All and SOC in 18 health facilities of the Shiselweni region, from October 2014 to March 2016. SOC followed the CD4 350 and 500 cells/mm3 treatment eligibility thresholds. Kaplan‐Meier estimates were used to describe crude programmatic outcomes. Multivariate flexible parametric survival models were built to assess associations of time from ART initiation with the composite unfavourable outcome of all‐cause attrition and viral failure. Results Of the 3170 patients, 1888 (59.6%) initiated ART under Treat‐All at a median CD4 cell count of 329 (IQR 168 to 488) cells/mm3 compared with 292 (IQR 161 to 430) (p < 0.001) under SOC. Although crude programme retention at 36 months tended to be lower under Treat‐All (71%) than SOC (75%) (p = 0.002), it was similar in covariate‐adjusted analysis (adjusted hazard ratio [aHR] 1.06, 95% CI 0.91 to 1.23). The hazard of viral suppression was higher for Treat‐All (aHR 1.12, 95% CI 1.01 to 1.23), while the hazard of viral failure was comparable (Treat‐All: aHR 0.89, 95% CI 0.53 to 1.49). Among patients with advanced HIV disease (n = 1080), those under Treat‐All (aHR 1.13, 95% CI 0.88 to 1.44) had a similar risk of an composite unfavourable outcome to SOC. Factors increasing the risk of the composite unfavourable outcome under both interventions were aged 16 to 24 years, being unmarried, anaemia, ART initiation on the same day as HIV care enrolment and CD4 ≤ 100 cells/mm3. Under Treat‐All only, the risk of the unfavourable outcome was higher for pregnant women, WHO III/IV clinical stage and elevated creatinine. Conclusions Compared to SOC, Treat‐All resulted in comparable retention, improved viral suppression and comparable composite outcomes of retention without viral failure.

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Supportive interventions to improve retention on ART in people with HIV in low- and middle-income countries: A systematic review

Cited by 35 publications

References 30 publications

Mortality and risk of tuberculosis among people living with HIV in whom TB was initially ruled out

Mortality and risk of tuberculosis among people living with HIV in whom TB was initially ruled out

Emerging priorities for HIV service delivery

HIV programmatic outcomes following implementation of the ‘Treat‐All’ policy in a public sector setting in Eswatini: a prospective cohort study

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