Study protocol: Strengthening understanding of effective adherence strategies for first-line and second-line antiretroviral therapy (ART) in selected rural and urban communities in South Africa

Multiple factors make adherence to antiretroviral therapy (ART) a complex process. This study aims to describe the barriers and facilitators to adherence for patients receiving first-line and second-line ART, identify different adherence strategies utilized and make recommendations for an improved adherence strategy. This mixed method parallel convergent study will be conducted in seven high volume public health facilities in Gauteng and one in Limpopo province in South Africa. The study consists of four phases; a retrospective secondary data analysis of a large cohort of patients on ART (using TIER.Net, an ART patient and data management system for recording and monitoring patients on ART and tuberculosis (TB) from seven Johannesburg inner-city public health facilities (Gauteng province); a secondary data analysis of the Intensified Treatment Monitoring Accumulation (ITREMA) trial (a randomized control trial which ran from June 2015 to January 2019) conducted at the Ndlovu Medical Center (Limpopo province); in-depth interviews with HIV infected patients on ART (in both urban and rural settings); and a systematic review of the impact of treatment adherence interventions for chronic conditions in sub-Saharan Africa. Data will be collected on demographics, socio-economic status, treatment support, retention in care status, disclosure, stigma, clinical markers (CD4 count and viral load), self-reported adherence information, intrapersonal, and interpersonal factors, community networks, and policy level factors. The systematic review will follow the PRISMA reporting and PICO criteria. Analyses will involve tests of association (Chi-square and t-test), thematic analysis (deductive and inductive approaches) and network meta-analysis. Using an integrated multilevel socio-ecological framework this study will describe the factors associated with adherence for HIV infected patients who are taking first-line or second-line ART. Implementing evidence-based adherence approaches, when taken up, will improve patients overall health outcomes. Our study results will provide guidance regarding context-specific intervention strategies to improve ART adherence.

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Study protocol: Strengthening understanding of effective adherence strategies for first-line and second-line antiretroviral therapy (ART) in selected rural and urban communities in South Africa

PLoS ONE ◽

10.1371/journal.pone.0261107 ◽

2021 ◽

Vol 16 (12) ◽

pp. e0261107

Author(s):

Siphamandla Bonga Gumede ◽

John Benjamin Frank de Wit ◽

Willem Daniel Francois Venter ◽

Samanta Tresha Lalla-Edward

Keyword(s):

Public Health ◽

South Africa ◽

Systematic Review ◽

Data Analysis ◽

Antiretroviral Therapy ◽

Meta Analysis ◽

Secondary Data ◽

Limpopo Province ◽

Second Line ◽

First Line

Multiple factors make adherence to antiretroviral therapy (ART) a complex process. This study aims to describe the barriers and facilitators to adherence for patients receiving first-line and second-line ART, identify different adherence strategies utilized and make recommendations for an improved adherence strategy. This mixed method parallel convergent study will be conducted in seven high volume public health facilities in Gauteng and one in Limpopo province in South Africa. The study consists of four phases; a retrospective secondary data analysis of a large cohort of patients on ART (using TIER.Net, an ART patient and data management system for recording and monitoring patients on ART and tuberculosis (TB)) from seven Johannesburg inner-city public health facilities (Gauteng province); a secondary data analysis of the Intensified Treatment Monitoring Accumulation (ITREMA) trial (a randomized control trial which ran from June 2015 to January 2019) conducted at the Ndlovu Medical Center (Limpopo province); in-depth interviews with people living with Human Immunodeficiency Virus (PLHIV) who are taking ART (in both urban and rural settings); and a systematic review of the impact of treatment adherence interventions for chronic conditions in sub-Saharan Africa. Data will be collected on demographics, socio-economic status, treatment support, retention in care status, disclosure, stigma, clinical markers (CD4 count and viral load (VL)), self-reported adherence information, intrapersonal, and interpersonal factors, community networks, and policy level factors. The systematic review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) reporting and Population, Interventions, Comparisons and Outcomes (PICO) criteria. Analyses will involve tests of association (Chi-square and t-test), thematic analysis (deductive and inductive approaches) and network meta-analysis. Using an integrated multilevel socio-ecological framework this study will describe the factors associated with adherence for PLHIV who are taking first-line or second-line ART. Implementing evidence-based adherence approaches, when taken up, will improve patient’s overall health outcomes. Our study results will provide guidance regarding context-specific intervention strategies to improve ART adherence.

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Attrition and Its Predictors Among Adults Receiving First-Line Antiretroviral Therapy in Woldia Town Public Health Facilities, Northeast Ethiopia: A Retrospective Cohort Study

HIV/AIDS - Research and Palliative Care ◽

10.2147/hiv.s304657 ◽

2021 ◽

Vol Volume 13 ◽

pp. 445-454

Author(s):

Demeke Dejen ◽

Dube Jara ◽

Fanos Yeshanew ◽

Zinabu Fentaw ◽

Tesfa Mengie Feleke ◽

...

Keyword(s):

Public Health ◽

Cohort Study ◽

Antiretroviral Therapy ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Health Facilities ◽

First Line ◽

Public Health Facilities ◽

Northeast Ethiopia

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Rates and Predictors of Failure of First-line Antiretroviral Therapy and Switch to Second-line ART in South Africa

JAIDS Journal of Acquired Immune Deficiency Syndromes ◽

10.1097/qai.0b013e3182557785 ◽

2012 ◽

Vol 60 (4) ◽

pp. 428-437 ◽

Cited By ~ 89

Author(s):

Matthew P. Fox ◽

Gilles Van Cutsem ◽

Janet Giddy ◽

Mhairi Maskew ◽

Olivia Keiser ◽

...

Keyword(s):

South Africa ◽

Antiretroviral Therapy ◽

Second Line ◽

First Line

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Increased vulnerability of rural children on antiretroviral therapy attending public health facilities in South Africa: a retrospective cohort study

Journal of the International AIDS Society ◽

10.1186/1758-2652-13-46 ◽

2010 ◽

Vol 13 (1) ◽

pp. 46-46 ◽

Cited By ~ 13

Author(s):

Geoffrey Fatti ◽

Peter Bock ◽

Ashraf Grimwood ◽

Brian Eley

Keyword(s):

Public Health ◽

South Africa ◽

Cohort Study ◽

Antiretroviral Therapy ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Health Facilities ◽

Rural Children ◽

Public Health Facilities

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PCN2 First-LINE Maintenance and Second-LINE Treatment of Advanced or Metastatic Gastric Cancer: A Systematic Review of Literature

Value in Health ◽

10.1016/j.jval.2020.08.139 ◽

2020 ◽

Vol 23 ◽

pp. S421

Author(s):

B. Singh ◽

S. Attri ◽

G. Kaur ◽

J. Flynn

Keyword(s):

Gastric Cancer ◽

Systematic Review ◽

Metastatic Gastric Cancer ◽

Line Treatment ◽

Second Line ◽

Review Of Literature ◽

First Line

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Comparing effectiveness of first‐line antiretroviral therapy between peri‐urban and rural clinics in KwaZulu‐Natal, South Africa

HIV Medicine ◽

10.1111/hiv.13231 ◽

2022 ◽

Author(s):

Jaysingh Brijkumar ◽

Johnathan A. Edwards ◽

Brent A. Johnson ◽

Claudia Ordonez ◽

Henry Sunpath ◽

...

Keyword(s):

South Africa ◽

Antiretroviral Therapy ◽

First Line ◽

Kwazulu Natal ◽

Rural Clinics

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A secondary data analysis of qualitative study of individualized treatment regimen for North Indians living with human immunodeficiency virus-1

10.21203/rs.3.rs-744951/v2 ◽

2021 ◽

Author(s):

Sushanta Kumar Barik ◽

Avi Kumar Bansal ◽

Ashwini Yadav ◽

Srikanth Prasad Tripathy ◽

Tej Pal Singh ◽

...

Keyword(s):

Drug Resistance ◽

Data Analysis ◽

Secondary Data ◽

First Line ◽

Cd4 Counts ◽

Viral Loads ◽

Indian Patients ◽

Resistance Patterns ◽

Endpoint Data ◽

The Individual

Abstract The follow-up of fifty-seven patients were conducted after a confirmation genotyping test. The secondary data analysis was done on the data available to observe the correlation between the CD4 counts and viral loads (One of the markers of clinical outcome) of the individual North Indian patients infected with HIV-1 Subtype C. The drug resistance mutations in individual patient were analysed through the drug resistance database, Stanford University, USA. The data of resistance associated with drugs, CD4 counts, viral loads of the individual patient was compiled and statistically analysed for drug resistance pattern profiles using Microsoft Excel 2016 and SPSS Version 22. The normality of data was checked by Shapiro-Wilk test (p<0.05). The study starting and endpoint data on CD4 counts, viral loads and drug resistance patterns associated with multiple first-line ART was available for 24 north Indian patients. The starting and study endpoint data on CD4 counts and drug resistance patterns associated with multiple first- line ART was available for 33 North Indian patients. The study indicative that the recommendation of policy to provide a tailor-made individualized regimen to each patient under AIDS control program.

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First-line antiretroviral therapy after single-dose nevirapine exposure in South Africa: a cost-effectiveness analysis of the OCTANE trial

AIDS ◽

10.1097/qad.0b013e3283428cbe ◽

2011 ◽

Vol 25 (4) ◽

pp. 479-492 ◽

Cited By ~ 21

Author(s):

Andrea L Ciaranello ◽

Shahin Lockman ◽

Kenneth A Freedberg ◽

Michael Hughes ◽

Jennifer Chu ◽

...

Keyword(s):

South Africa ◽

Single Dose ◽

Cost Effectiveness ◽

Antiretroviral Therapy ◽

Cost Effectiveness Analysis ◽

First Line ◽

Effectiveness Analysis ◽

Single Dose Nevirapine

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Determinants of virological failure among adults on first-line highly active antiretroviral therapy at public health facilities in Kombolcha town, Northeast, Ethiopia: a case–control study

BMJ Open ◽

10.1136/bmjopen-2019-036223 ◽

2020 ◽

Vol 10 (7) ◽

pp. e036223

Author(s):

Habtamu Mengist Meshesha ◽

Zelalem Mehari Nigussie ◽

Anemaw Asrat ◽

Kebadnew Mulatu

Keyword(s):

Public Health ◽

Antiretroviral Therapy ◽

Virological Failure ◽

Highly Active Antiretroviral Therapy ◽

Case Control Study ◽

Case Control ◽

First Line ◽

Highly Active ◽

Northeast Ethiopia ◽

Control Study

ObjectiveTo identify determinants of virological failure among HIV-infected adults on first-line highly active antiretroviral therapy at public health facilities in Kombolcha town, Northeast, Ethiopia, in 2019.MethodsAn unmatched case–control study was conducted from April to May 2019. About 130 cases and 259 controls were selected by simple random sampling. Data were extracted from charts of patients using a structured checklist. Multiple logistic regression analysis was performed to identify possible factors. Hosmer-Lemeshow goodness of fit test was used to check the model. Finally, independent predictor variables of virological failure were identified based on adjusted OR (AOR) with 95% CI and a p value of 0.05.ResultsThe odds of virological failure were 2.4-fold (AOR=2.44, 95% CI 1.353 to 4.411) higher in clients aged <35 years compared with older clients, fivefold (AOR=5.00, 95% CI 2.60 to 9.63) higher in clients who did not disclose their HIV status, threefold (AOR=2.99, 95% CI 1.33 to 6.73) higher in clients with poor adherence, and 7.5-fold (AOR=7.51, 95% CI 3.98 to 14.14) higher in clients who had recent CD4 count of ≤250 cells/mm3.Conclusion and recommendationThis study revealed that age, marital status, occupation, disclosure status, baseline functional status, missed clinic visit, current antiretroviral therapy regimen, adherence to treatment and recent CD4 count were significantly associated with virological failure. Therefore, adherence support should be strengthened among clients. Missed clinic visits should also be reduced, as it could help clients better adhere to treatment, and therefore boost their immunity and suppress viral replication.

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