“Wan Kanyakla” (We are together): Community transformations in Kenya following a social network intervention for HIV care

Salmen, Charles R.; Hickey, Matthew D.; Fiorella, Kathryn J.; Omollo, Dan; Ouma, Gor Benard; Zoughbie, Daniel E.; Salmen, Marcus; Magerenge, Richard; Tessler, Robert A.; Campbell, Harold; Geng, Elvin; Gandhi, Monica; Bukusi, Elizabeth A.; Cohen, Craig R.

doi:10.1016/j.socscimed.2015.11.021

Cited by 31 publications

(34 citation statements)

References 48 publications

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“…Eighteen studies (20.7%) used focus group discussions (FDGs) [19,23–25,28,50,53,61,68,73,74,76,77,82,94,98,167,169], 16 used both IDIs and FDGs (18.4%) [18,30,31,38,44,52,64,72,75,79,83,86,92,93,99,170], one used free attitude interviews (FAIs) and FGDs (1.1%) [80], one used group sessions without more detail [168], one used IDIs and life history and illness narratives [48] and one used digital stories [91]. …”

Section: Resultsmentioning

confidence: 99%

Patient-reported barriers and facilitators to antiretroviral adherence in sub-Saharan Africa

Croome

Ahluwalia²,

Hughes³

et al. 2017

Aids

136

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Objective:The aim of this study was to identify the range and frequency of patient-reported barriers and facilitators to antiretroviral treatment (ART) adherence in sub-Saharan Africa (SSA).Design:Studies from 2005 to 2016 were identified by searching 10 electronic databases and through additional hand and web-searching.Methods:Inclusion criteria were HIV-positive adults taking ART based in any SSA country, qualitative study or quantitative survey and included at least one patient-reported barrier or facilitator to ART adherence. Exclusion criteria were only including data from treatment-naive patients initiating ART, only single-dose treatment, participants residing outside of SSA and reviews.Results:After screening 11 283 records, 154 studies (161 papers) were included in this review. Forty-three barriers and 30 facilitators were reported across 24 SSA countries. The most frequently identified barriers across studies were forgetting (n = 76), lack of access to adequate food (n = 72), stigma and discrimination (n = 68), side effects (n = 67) and being outside the house or travelling (n = 60). The most frequently identified facilitators across studies were social support (n = 60), reminders (n = 55), feeling better or healthier after taking ART (n = 35), disclosing their HIV status (n = 26) and having a good relationship with a health provider (n = 22).Conclusion:This review addresses the gap in knowledge by collating all the patient-reported barriers and facilitators to ART adherence in SSA. Current barriers measures need to be adapted or new tools developed to include the wide variety of factors identified. The factors that have the greatest impact need to be isolated so interventions are developed that reduce the barriers and enhance the facilitators.

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Section: Resultsmentioning

confidence: 99%

Patient-reported barriers and facilitators to antiretroviral adherence in sub-Saharan Africa

Croome

Ahluwalia²,

Hughes³

et al. 2017

Aids

136

View full text Add to dashboard Cite

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“…13 Likewise, a diverse set of interventions targeting retention in care such as text messages, microclinics, and others have shown the ability to improve retention and adherence. 14,26–28 Enhanced testing and retention interventions, however, will achieve maximal effects on public health only if these steps in the cascade are efficiently linked by ART initiation.…”

Section: Discussionmentioning

confidence: 99%

Effects of a multicomponent intervention to streamline initiation of antiretroviral therapy in Africa: a stepped-wedge cluster-randomised trial

et al. 2016

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Summary Background In Africa, up to 30% of HIV-infected patients who are clinically eligible for antiretroviral therapy (ART) do not start timely treatment. We assessed the effects of an intervention targeting prevalent health systems barriers to ART initiation on timing and completeness of treatment initiation. Methods In this stepped-wedge, non-blinded, cluster-randomised controlled trial, 20 clinics in southwestern Uganda were randomly assigned in groups of five clinics every 6 months to the intervention by a computerised random number generator. This procedure continued until all clinics had crossed over from control (standard of care) to the intervention, which consisted of opinion-leader-led training and coaching of front-line health workers, a point-of-care CD4 cell count testing platform, a revised counselling approach without mandatory multiple pre-initiation sessions, and feedback to the facilities on their ART initiation rates and how they compared with other facilities. Treatment-naive, HIV-infected adults (aged ≥18 years) who were clinically eligible for ART during the study period were included in the study population. The primary outcome was ART initiation 14 days after first clinical eligibility for ART. This study is registered with ClinicalTrials.gov, number NCT01810289. Findings Between April 11, 2013, and Feb 2, 2015, 12 024 eligible patients visited one of the 20 participating clinics. Median CD4 count was 310 cells per μL (IQR 179–424). 3753 of 4747 patients (weighted proportion 80%) in the intervention group had started ART by 2 weeks after eligibility compared with 2585 of 7066 patients (38%) in the control group (risk difference 41·9%, 95% CI 40·1–43·8). Vital status was ascertained in a random sample of 208 patients in the intervention group and 199 patients in the control group. Four deaths (2%) occurred in the intervention group and five (3%) occurred in the control group. Interpretation A multicomponent intervention targeting health-care worker behaviour increased the probability of ART initiation 14 days after eligibility. This intervention consists of widely accessible components and has been tested in a real-world setting, and is therefore well positioned for use at scale. Funding National Institute of Allergy and Infectious Diseases (NIAID) and the President’s Emergency Fund for AIDS Relief (PEPFAR).

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“…23 MIHNIS evaluates the impact of a social- support “microclinic” intervention on adherence amongst HIV-infected individuals. Participants were recruited from a rural level-3 health facility on Mfangano Island supported by Family AIDS Care & Education Services, a President’s Emergency Plan for AIDS Relief-funded collaboration between the University of California San Francisco (UCSF) and the Kenya Medical Research Institute (KEMRI).…”

Section: Methodsmentioning

confidence: 99%

Antiretroviral Concentrations in Small Hair Samples as a Feasible Marker of Adherence in Rural Kenya

Hickey

Salmen

Tessler

et al. 2014

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Antiretroviral hair levels objectively quantify drug exposure over time and predict virologic responses. We assessed the acceptability and feasibility of collecting small hair samples in a rural Kenyan cohort. 95% of participants (354/373) donated hair. Although median self-reported adherence was 100% (IQR 96–100%), a wide range of hair concentrations likely indicates overestimation of self-reported adherence and the advantages of a pharmacologic adherence measure. Higher nevirapine (NVP) hair concentrations observed in women and older adults require further study to unravel behavioral versus pharmacokinetic contributors. In resource-limited settings, hair antiretroviral levels may serve as a low-cost quantitative biomarker of adherence.

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“Wan Kanyakla” (We are together): Community transformations in Kenya following a social network intervention for HIV care

Cited by 31 publications

References 48 publications

Patient-reported barriers and facilitators to antiretroviral adherence in sub-Saharan Africa

Patient-reported barriers and facilitators to antiretroviral adherence in sub-Saharan Africa

Effects of a multicomponent intervention to streamline initiation of antiretroviral therapy in Africa: a stepped-wedge cluster-randomised trial

Antiretroviral Concentrations in Small Hair Samples as a Feasible Marker of Adherence in Rural Kenya

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