The Treatment Ambassador Program: A Highly Acceptable and Feasible Community-Based Peer Intervention for South Africans Living with HIV Who Delay or Discontinue Antiretroviral Therapy

Abstract Background Multi-month dispensing (MMD) is the mainstay mechanism for clinically stable people living with HIV in Cambodia to refill antiretroviral therapy (ART) every 3-6 months. However, less frequent ART dispensing through the community-based ART delivery (CAD) model could further reduce the clients’ and health facilities’ burden. While community-based services have been recognized as an integral component of HIV response in Cambodia, their role and effectiveness in ART delivery have yet to be systematically assessed. This study aims to evaluate the CAD model’s effectiveness on the continuum of care and treatment outcomes for stable people living with HIV in Cambodia. Methods We will conduct this quasi-experimental study in 20 ART clinics across the capital city and nine provinces between May 2021 and April 2023. Study sites were purposively selected based on the availability of implementing partners, the number of people living with HIV each clinic serves, and the accessibility of the clinics. In the intervention arm, approximately 2000 stable people living with HIV will receive ART and services from the CAD model. Another 2000 stable people living with HIV in the control arm will receive MMD—a standard care model for stable people living with HIV. The primary outcomes will be retention in care, viral load suppression, and adherence to ART. The secondary endpoints will include health providers’ work burden, the model’s cost-effectiveness, quality of life, mental health, social support, stigma, and discrimination. We will compare the outcome indicators within each arm at baseline, midline, and endline using descriptive and inferential statistics. We will evaluate the differences between the intervention and control arms using the difference-in-differences method. We will perform economic evaluations to determine if the intervention is cost-effective. Discussion This study will build the evidence base for future implementation and scale-up of CAD model in Cambodia and other similar settings. Furthermore, it will strengthen engagements with community stakeholders and further improve community mobilization, a vital pillar of the Cambodian HIV response. Trial registration ClinicalTrials.gov, NCT04766710. Registered 23 February 2021, Version 1.

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Community-based model for the delivery of antiretroviral therapy in Cambodia: a quasi-experimental study protocol

10.21203/rs.3.rs-497277/v1 ◽

2021 ◽

Author(s):

Sovannary Tuot ◽

Alvin Kuo Jing Teo ◽

Kiesha Prem ◽

Pheak Chhoun ◽

Chamroen Pall ◽

...

Keyword(s):

Experimental Study ◽

Antiretroviral Therapy ◽

Scale Up ◽

Economic Evaluations ◽

People Living With Hiv ◽

Cad Model ◽

Community Based ◽

Quasi Experimental ◽

Living With Hiv ◽

Art Delivery

Abstract BackgroundMulti-month dispensing (MMD) is the mainstay mechanism for clinically stable people living with HIV in Cambodia to refill antiretroviral therapy (ART) every three to six months. However, less frequent ART dispensing through the community-based ART delivery (CAD) model could further reduce the clients’ and health facilities' burden. While community-based services have been recognized as an integral component of HIV response in Cambodia, their role and effectiveness in ART delivery have yet to be systematically assessed. This study aims to evaluate the CAD model's effectiveness on the continuum of care and treatment outcomes for stable people living with HIV in Cambodia.MethodsWe will conduct this quasi-experimental study in 20 ART clinics across the capital city and 10 provinces between May 2021 and April 2023. Study sites were purposively selected based on the availability of implementing partners, the number of people living with HIV each clinic serves, and the accessibility of the clinics. In the intervention arm, approximately 2,000 stable people living with HIV will receive ART and services from the CAD model. Another 2000 stable people living with HIV in the control arm will receive MMD—a standard care model for stable people living with HIV. The primary outcomes will be retention in care, viral load suppression, and the healthcare providers’ work burden. The secondary endpoints will include the model’s cost-effectiveness, quality of life, mental health, social support, stigma, and discrimination. We will compare the outcome indicators within each arm at baseline, midline, and endline using descriptive and inferential statistics. We will evaluate the differences between the intervention and control arms using the difference-in-differences method. We will perform economic evaluations to determine if the intervention is cost-effective.DiscussionThis study will build the evidence base for future implementation and scale-up of CAD model in Cambodia and other similar settings. Furthermore, it will strengthen engagements with community stakeholders and further improve community mobilization, a vital pillar of the Cambodian HIV response.Trial registrationClinicalTrials.gov, NCT04766710. Registered 23 February 2021,

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Do disability grants influence adherence to antiretroviral therapy?

African Journal of Disability ◽

10.4102/ajod.v3i1.100 ◽

2014 ◽

Vol 3 (1) ◽

Cited By ~ 1

Author(s):

Ashraf Kagee

Keyword(s):

Antiretroviral Therapy ◽

Empirical Data ◽

Cd4 Count ◽

Structural Barriers ◽

Difficult Patient ◽

Antiretroviral Adherence ◽

South Africans ◽

Antiretroviral Medication ◽

Perverse Incentives ◽

Living With Hiv

Anecdotal data suggest that some South Africans living with HIV who receive disability grants from the state deliberately default on their antiretroviral medication in an attempt to lower their CD4 count to remain eligible for grants. No actual empirical data however exist to show that disability grants act as such perverse incentives and are a valid reason for non-adherence. This article examines some of the complexities of antiretroviral adherence in the context of a resource-constrained environment. The multitude of structural barriers, including sometimes difficult patient-doctor conversations about the renewal of disability grants, shape patients’ experiences of the clinic environment and influence their adherence to care.

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HIV Status and Antiretroviral Therapy as Predictors of Disability among Older South Africans: Overall Association and Moderation by Body Mass Index

Journal of Aging and Health ◽

10.1177/0898264320925323 ◽

2020 ◽

Vol 32 (10) ◽

pp. 1335-1344

Author(s):

Stephen B. Asiimwe ◽

Livia Montana ◽

Kathleen Kahn ◽

Stephen M. Tollman ◽

Chodziwadziwa W. Kabudula ◽

...

Keyword(s):

Body Mass Index ◽

Antiretroviral Therapy ◽

Body Mass ◽

Sex Education ◽

Care Utilization ◽

People Living With Hiv ◽

Hiv Status ◽

South Africans ◽

Primary Health ◽

Living With Hiv

Objectives: Among older people living with HIV (PLWH) and comparable individuals without HIV, we evaluated whether associations of HIV and antiretroviral therapy (ART) with disability depend on body mass index (BMI). Methods: We analyzed 4552 participants in the “Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa.” (HAALSI) We compared prevalence of disability (≥1 impairment in basic activities of daily living) by HIV status, ART use, and BMI category, adjusting for age, sex, education, father’s occupation, country of origin, lifetime alcohol use, and primary health-care utilization. Results: Among PLWH, those underweight had 9.8% points (95% confidence interval (CI): 1.2 to 18.4) higher prevalence of disability than those with normal BMI. Among ART users, those underweight had 11.9% points (95% CI: 2.2 to 21.6) higher prevalence of disability than those with normal BMI. Conclusions: We found no evidence that weight improvement associated with ART use is likely to increase disability.

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Overview of systematic reviews on strategies to improve treatment initiation, adherence to antiretroviral therapy and retention in care for people living with HIV: part 1

BMJ Open ◽

10.1136/bmjopen-2019-034793 ◽

2020 ◽

Vol 10 (9) ◽

pp. e034793

Author(s):

Lawrence Mbuagbaw ◽

Anisa Hajizadeh ◽

Annie Wang ◽

Dominik Mertz ◽

Daeria O Lawson ◽

...

Keyword(s):

Antiretroviral Therapy ◽

Vulnerable Populations ◽

Systematic Reviews ◽

Retention In Care ◽

Research Quality ◽

Cochrane Library ◽

People Living With Hiv ◽

Community Based ◽

Overview Of Systematic Reviews ◽

Living With Hiv

ObjectivesWe sought to map the evidence and identify interventions that increase initiation of antiretroviral therapy, adherence to antiretroviral therapy and retention in care for people living with HIV at high risk for poor engagement in care.MethodsWe conducted an overview of systematic reviews and sought for evidence on vulnerable populations (men who have sex with men (MSM), African, Caribbean and Black (ACB) people, sex workers (SWs), people who inject drugs (PWID) and indigenous people). We searched PubMed, Excerpta Medica dataBASE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Web of Science and the Cochrane Library in November 2018. We screened, extracted data and assessed methodological quality in duplicate and present a narrative synthesis.ResultsWe identified 2420 records of which only 98 systematic reviews were eligible. Overall, 65/98 (66.3%) were at low risk of bias. Systematic reviews focused on ACB (66/98; 67.3%), MSM (32/98; 32.7%), PWID (6/98; 6.1%), SWs and prisoners (both 4/98; 4.1%). Interventions were: mixed (37/98; 37.8%), digital (22/98; 22.4%), behavioural or educational (9/98; 9.2%), peer or community based (8/98; 8.2%), health system (7/98; 7.1%), medication modification (6/98; 6.1%), economic (4/98; 4.1%), pharmacy based (3/98; 3.1%) or task-shifting (2/98; 2.0%). Most of the reviews concluded that the interventions effective (69/98; 70.4%), 17.3% (17/98) were neutral or were indeterminate 12.2% (12/98). Knowledge gaps were the types of participants included in primary studies (vulnerable populations not included), poor research quality of primary studies and poorly tailored interventions (not designed for vulnerable populations). Digital, mixed and peer/community-based interventions were reported to be effective across the continuum of care.ConclusionsInterventions along the care cascade are mostly focused on adherence and do not sufficiently address all vulnerable populations.

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