The development of an intervention to support uptake and adherence to antiretroviral therapy in people living with HIV: the SUPA intervention. A brief report

2021 ◽  
Author(s):  
Kathryn King ◽  
Rob Horne ◽  
Vanessa Cooper ◽  
Elizabeth Glendinning ◽  
Susan Michie ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Focus Groups ◽  
Controlled Trial ◽  
Complex Interventions ◽  
People Living With Hiv ◽  
Adherence To Treatment ◽  
Behavior Change Techniques ◽  
High Level ◽  
Living With Hiv

Abstract The effectiveness of antiretroviral therapy (ART) depends on prompt uptake of treatment and a high level of adherence over the long-term, yet these behaviors are suboptimal. Previous interventions have significantly improved adherence but effect sizes are generally small. The aim of this article is to describe the design and content of an intervention to support uptake and adherence to treatment in HIV positive patients (SUPA intervention), utilizing cognitive behavioral and motivational interviewing (MI) techniques. The intervention was developed in line with Medical Research Council (MRC) guidance for the development of complex interventions and informed by the NICE (National Institute for Health and Care Excellence) Guidelines for adherence, empirical evidence and focus groups. Behavior change techniques were mapped to perceptual and practical barriers to uptake and adherence to ART, identified in previous research. Intervention materials were designed and later discussed within focus groups, where feedback enabled an iterative process of development. We conclude it is possible to transparently report the design and content of a theory-based intervention to increase uptake and adherence to ART. The intervention has been evaluated within a randomized controlled trial (RCT) at 10 HIV clinics in England, the results of which will be reported elsewhere.

scholarly journals Protocol of a randomized controlled trial to test the effects of client-centered Representative Payee Services on antiretroviral therapy adherence among marginalized people living with HIV

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Abisola Olaniyan ◽  
Stephanie L. Creasy ◽  
D. Scott Batey ◽  
Maria Mori Brooks ◽  
Catherine Maulsby ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Viral Load ◽  
Antiretroviral Therapy ◽  
Health Outcomes ◽  
Controlled Trial ◽  
People Living With Hiv ◽  
Randomized Controlled ◽  
Antiretroviral Therapy Adherence ◽  
Living With Hiv ◽  
Representative Payee

Abstract Background Client-Centered Representative Payee (CCRP) is an intervention modifying implementation of a current policy of the US Social Security Administration, which appoints organizations to serve as financial payees on behalf of vulnerable individuals receiving Social Security benefits. By ensuring beneficiaries’ bills are paid while supporting their self-determination, this structural intervention may mitigate the effects of economic disadvantage to improve housing and financial stability, enabling self-efficacy for health outcomes and improved antiretroviral therapy adherence. This randomized controlled trial will test the impact of CCRP on marginalized people living with HIV (PLWH). We hypothesize that helping participants to pay their rent and other bills on time will improve housing stability and decrease financial stress. Methods PLWH (n = 160) receiving services at community-based organizations will be randomly assigned to the CCRP intervention or the standard of care for 12 months. Fifty additional participants will be enrolled into a non-randomized (“choice”) study allowing participant selection of the CCRP intervention or control. The primary outcome is HIV medication adherence, assessed via the CASE adherence index, viral load, and CD4 counts. Self-assessment data for ART adherence, housing instability, self-efficacy for health behaviors, financial stress, and retention in care will be collected at baseline, 3, 6, and 12 months. Viral load, CD4, and appointment adherence data will be collected at baseline, 6, 12, 18, and 24 months from medical records. Outcomes will be compared by treatment group in the randomized trial, in the non-randomized cohort, and in the combined cohort. Qualitative data will be collected from study participants, eligible non-participants, and providers to explore underlying mechanisms of adherence, subjective responses to the intervention, and implementation barriers and facilitators. Discussion The aim of this study is to determine if CCRP improves health outcomes for vulnerable PLWH. Study outcomes may provide information about supports needed to help economically fragile PLWH improve health outcomes and ultimately improve HIV health disparities. In addition, findings may help to refine service delivery including the provision of representative payee to this often-marginalized population. This protocol was prospectively registered on May 22, 2018 with ClinicalTrials.gov (NCT03561103).

scholarly journals Treatment Literacy of People Living with HIV (PLHIV) in Government Healthcare Facilities in Malaysia

2021 ◽  
Vol 11 (9) ◽  
pp. 79-82
Author(s):  
Zailatul Hani Mohamad Yadzir ◽  
Mazliza Ramly ◽  
Anita Suleiman
Keyword(s):  
Antiretroviral Therapy ◽  
Cross Sectional Study ◽  
Load Test ◽  
People Living With Hiv ◽  
Cross Sectional ◽  
Healthcare Facilities ◽  
Viral Load Test ◽  
High Level ◽  
Immunodeficiency Syndrome ◽  
Living With Hiv

Background: Treatment literacy is a significant factor in the management of health and care of people living with HIV (PLHIV). Therefore, the aim of this study was to determine the level of treatment literacy among PLHIV in selected government facilities. Methods: A cross-sectional study was undertaken from July to August 2020 in five government hospitals and six government health clinics in Malaysia. A validated self-administered questionnaire encompassing six items about treatment literacy was used to assess the knowledge of PLHIV. This survey was conducted via web-based platform. Results: Overall, 1173 PLHIV participated in this study. The major finding in this study was that 90.0% of PLHIV were currently on treatment and aware of their antiretroviral therapy (ART) regime. Majority of PLHIV (74.0%) also stated that they know the frequency of receiving their viral load test. Conclusion: The study found a high level of treatment literacy among PLHIV in selected government facilities in Malaysia. Key words: Human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), people living with HIV (PLHIV), antiretroviral therapy (ART)

scholarly journals Antiretroviral therapy adherence and self-efficacy among people living with HIV and a history of drug use in Vietnam

2017 ◽  
Vol 28 (12) ◽  
pp. 1247-1254 ◽  
Author(s):  
Li Li ◽  
Chunqing Lin ◽  
Sung-Jae Lee ◽  
Le Anh Tuan ◽  
Nan Feng ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Drug Use ◽  
Treatment Adherence ◽  
Self Efficacy ◽  
Controlled Trial ◽  
People Living With Hiv ◽  
Cross Sectional ◽  
Heroin Use ◽  
History Of ◽  
Living With Hiv

People living with HIV with a history of drug use face additional psychosocial challenges that could compromise their adherence to antiretroviral therapy (ART). This study examined ART treatment adherence and adherence self-efficacy among people living with HIV with a history of drug use in Vietnam. We used cross-sectional baseline data collected between October 2014 and February 2015 from a randomized controlled trial in Vietnam. Of the 900 persons with a history of drug use in the trial, a sample of 109 people living with HIV currently on ART were included in the study. The vast majority (92%) of the participants reported not missing any medications in the past 30 days. Multiple regression results indicated that social support was positively associated with adherence self-efficacy (β = 0.420, P < 0.001) and general adherence to ART (β = 0.201, P = 0.0368). General adherence to ART was negatively associated with depressive symptoms (β = −0.188, P = 0.046) and current heroin use (β = −0.196, P = 0.042). These findings underscore the importance of addressing mental health and social challenges facing people living with HIV with a history of drug use to promote ART treatment adherence. Clinical management of HIV should identify and address concurrent substance use behaviors to maximize adherence and treatment outcomes.

scholarly journals A web-based survey finds low antiretroviral therapy adherence in approximately 35% of Japanese people living with HIV

2021 ◽  
Author(s):  
Yoji Inoue ◽  
Shinichi Oka ◽  
Seiji Yokoyama ◽  
Koichi Hasegawa ◽  
Joerg Mahlich ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Severe Depression ◽  
Treatment Decision ◽  
Healthcare Team ◽  
People Living With Hiv ◽  
Related Factors ◽  
Web Based ◽  
Adherence Scale ◽  
Living With Hiv

Abstract Background: Long-term medical care for people living with HIV/AIDS (PLHIV) is critical for treatment efficacy, and various studies have examined causes of antiretroviral therapy (ART) non-adherence. Physicians are assuming that patients are maintaining high adherence. However, little is known about situation of the real-world adherence. Methods: We conducted an anonymous self-administered web-based survey that asking their adherence for a total of 1,030 Japanese PLHIV who were currently on ART. The adherence was judged in terms of the 8-item Morisky Medication Adherence Scale (MMAS-8). Data were analysed based on patient-related factors, therapy-related factors, condition-related factors, and healthcare team/system-related factors.Results: A total of 821 PLHIV responded to the survey were analysed further. Among them, 291 responders (35%) were identified as being in the low adherence group. The study showed a statistically significant relationship between the number of missed anti-HIV drug doses within the previous 2-week and the long-term adherence by the MMAS -8 score. Risk factors for low adherence included age (younger than 21 years), moderate to severe depression, and drug dependence. Adherence was also influenced by the shared decision-making process, including treatment selection, doctor-patient relations, and treatment satisfaction.Conclusions: A web-based survey found low ART adherence in approximately 35% of Japanese PLHIV. The adherence was mainly affected by factors for treatment decision. A medical team support is critical to improve adherence.

scholarly journals Peculiar Phenotypic and Cytotoxic Features of Pulmonary Mucosal CD8 T Cells in People Living with HIV Receiving Long-Term Antiretroviral Therapy

2020 ◽  
pp. ji2000916
Author(s):  
Oussama Meziane ◽  
Yulia Alexandrova ◽  
Ronald Olivenstein ◽  
Franck P. Dupuy ◽  
Syim Salahuddin ◽  
...  
Keyword(s):  
T Cells ◽  
Antiretroviral Therapy ◽  
Cd8 T Cells ◽  
People Living With Hiv ◽  
Living With Hiv

scholarly journals Antiretroviral Therapy Dampens Mucosal CD4+ T Lamina Propria Lymphocytes Immune Activation in Long-Term Treated People Living with HIV-1

2021 ◽  
Vol 9 (8) ◽  
pp. 1624
Author(s):  
Alessandro Lazzaro ◽  
Giuseppe Pietro Innocenti ◽  
Letizia Santinelli ◽  
Claudia Pinacchio ◽  
Gabriella De Girolamo ◽  
...  
Keyword(s):  
T Cells ◽  
Antiretroviral Therapy ◽  
Lamina Propria ◽  
Immune Activation ◽  
Cd4 T Cells ◽  
People Living With Hiv ◽  
Living With Hiv ◽  
Lamina Propria Lymphocytes ◽  
Hiv 1

HIV infection is characterized by a severe deterioration of an immune cell-mediated response due to a progressive loss of CD4+ T cells from gastrointestinal tract, with a preferential loss of IL-17 producing Th cells (Th17), a specific CD4+ T cells subset specialized in maintaining mucosal integrity and antimicrobial inflammatory responses. To address the effectiveness of antiretroviral therapy (ART) in reducing chronic immunological dysfunction and immune activation of intestinal mucosa, we conducted a cross-sectional observational study comparing total IFN-γ-expressing (Th1) and IL-17-expressing (Th17) frequencies of CD4+ T lamina propria lymphocytes (LPLs) and their immune activation status between 11 male ART-naïve and 11 male long-term ART-treated people living with HIV-1 (PLWH) who underwent colonoscopy and retrograde ileoscopy for biopsies collection. Flow cytometry for surface and intracellular staining was performed. Long-term ART-treated PLWH showed lower levels of CD38+ and/or HLA-DR+ LPLs compared to ART-naïve PLWH. Frequencies of Th1 and Th17 LPLs did not differ between the two groups. Despite ART failing to restore the Th1 and Th17 levels within the gut mucosa, it is effective in increasing overall CD4+ T LPLs frequencies and reducing mucosal immune activation.

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