scholarly journals PO 7139 CONDITIONAL ECONOMIC INCENTIVES AND MOTIVATIONAL INTERVIEWING TO IMPROVE ADOLESCENTS’ RETENTION AND ADHERENCE TO ANTIRETROVIRAL THERAPY IN NIGERIA: ARA TRIAL

2019 ◽  
Vol 4 (Suppl 3) ◽  
pp. A19.2-A19
Author(s):  
Obinna Ekwunife ◽  
Maureen Anetoh ◽  
Stephen Kalu ◽  
George Eleje
Keyword(s):  
Viral Load ◽  
Antiretroviral Therapy ◽  
Motivational Interviewing ◽  
Retention In Care ◽  
Economic Incentives ◽  
Hiv Care ◽  
Incentive Scheme ◽  
Anambra State ◽  
Adherence Support ◽  
The Impact

BackgroundAdolescent HIV patients have worse treatment outcomes compared to other age groups given their vulnerability to risk-taking behaviour. Limited evidence exists on the effectiveness of service delivery interventions to support adolescents’ retention in care and adherence to antiretroviral therapy (ART). The ARA trial tackles this challenge by evaluating the impact of conditional economic incentives coupled with motivational interviewing on adolescents’ retention in care and adherence to ART in Anambra State, Nigeria.MethodsThe study will be a cluster-randomised, controlled trial conducted in 12 HIV treatment hospitals in Anambra State, Nigeria. Six (6) hospitals each will be randomised to either intervention or control arm. A structured adherence support scheme, termed the Incentive Scheme, will be applied to the intervention hospitals while the control hospitals will receive routine HIV care. Additionally, patients in the intervention arm will receive motivational interviewing at baseline and following initiation of ART, they will receive a gift voucher of Nigerian Naira (NGN) 2000 when viral load (VL) is <20 copies/mL at 12 weeks, gift voucher of NGN 1000 if the VL remains suppressed for the next 3 months, and the next 6 months, and finally gift voucher of NGN 2000 if the VL remains <20 copies/mL at 1 year. All gift vouchers will be conditional not only on VL results but also on attending for motivational interviewing. The primary outcome for the trial will be the difference between groups in the proportion to HIV viral load suppression (≤20 copies/mL) by 12 months and then 24 months after withdrawal of the Incentive Scheme.ResultsThe protocol for ARA trial and planned activities is finalised. Application for approval for the trial is on-going.ConclusionThe proposed trial will provide evidence on the feasibility of applying the Incentive Scheme to improve retention and adherence to ART of adolescents living with HIV.

scholarly journals Cost-effectiveness and feasibility of conditional economic incentives and motivational interviewing to improve HIV health outcomes of adolescents living with HIV in Anambra State, Nigeria

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Obinna Ikechukwu Ekwunife ◽  
Chinelo Janefrances Ofomata ◽  
Charles Ebuka Okafor ◽  
Maureen Ugonwa Anetoh ◽  
Stephen Okorafor Kalu ◽  
...  
Keyword(s):  
Viral Load ◽  
Cost Effectiveness ◽  
Service Delivery ◽  
Motivational Interviewing ◽  
Cost Effective ◽  
Economic Incentives ◽  
Additional Patient ◽  
Incentive Scheme ◽  
The Cost ◽  
The Impact

Abstract Background In sub-Saharan Africa, there is increasing mortality and morbidity of adolescents due to poor linkage, retention in HIV care and adherence to antiretroviral therapy (ART). This is a result of limited adolescent-centred service delivery interventions. This cost-effectiveness and feasibility study were piggybacked on a cluster-randomized trial that assessed the impact of an adolescent-centred service delivery intervention. The service delivery intervention examined the impact of an incentive scheme consisting of conditional economic incentives and motivational interviewing on the health outcomes of adolescents living with HIV in Nigeria. Method A cost-effectiveness analysis from the healthcare provider’s perspective was performed to assess the cost per additional patient achieving undetected viral load through the proposed intervention. The cost-effectiveness of the incentive scheme over routine care was estimated using the incremental cost-effectiveness ratio (ICER), expressed as cost/patient who achieved an undetectable viral load. We performed a univariate sensitivity analysis to examine the effect of key parameters on the ICER. An in-depth interview was conducted on the healthcare personnel in the intervention arm to explore the feasibility of implementing the service delivery intervention in HIV treatment hospitals in Nigeria. Result The ICER of the Incentive Scheme intervention compared to routine care was US$1419 per additional patient with undetectable viral load. Going by the cost-effectiveness threshold of US$1137 per quality-adjusted life-years suggested by Woods et al., 2016, the intervention was not cost-effective. The sensitivity test showed that the intervention will be cost-effective if the frequency of CD4 count and viral load tests are reduced from quarterly to triannually. Healthcare professionals reported that patients’ acceptance of the intervention was very high. Conclusion The conditional economic incentives and motivational interviewing was not cost-effective, but can become cost-effective if the frequency of HIV quality of life indicator tests are performed 1–3 times per annum. Patients’ acceptance of the intervention was very high. However, healthcare professionals believed that sustaining the intervention may be difficult unless factors such as government commitment and healthcare provider diligence are duly addressed. Trial registration This trial is registered in the WHO International Clinical Trials Registry through the WHO International Registry Network (PACTR201806003040425).

scholarly journals Rapid Antiretroviral Therapy (ART) Initiation at a Community-Based Clinic in Jackson, MS

2020 ◽  
Vol 17 (1) ◽  
Author(s):  
Courtney E. Sims Gomillia ◽  
Kandis V. Backus ◽  
James B. Brock ◽  
Sandra C. Melvin ◽  
Jason J. Parham ◽  
...  
Keyword(s):  
Viral Load ◽  
Antiretroviral Therapy ◽  
Median Time ◽  
Viral Suppression ◽  
Hiv Care ◽  
Virologic Suppression ◽  
Community Based ◽  
Art Initiation ◽  
Healthcare Center ◽  
The Impact

Abstract Background Rapid antiretroviral therapy (ART), ideally initiated within twenty-four hours of diagnosis, may be crucial in efforts to increase virologic suppression and reduce HIV transmission. Recent studies, including demonstration projects in large metropolitan areas such as Atlanta, Georgia; New Orleans, Louisiana; San Francisco, California; and Washington D.C., have demonstrated that rapid ART initiation is a novel tool for expediting viral suppression in clinical settings. Here we present an evaluation of the impact of a rapid ART initiation program in a community-based clinic in Jackson, MS. Methods We conducted a retrospective chart review of patients who were diagnosed with HIV at Open Arms Healthcare Center or were linked to the clinic for HIV care by the Mississippi State Department of Health Disease Intervention Specialists from January 1, 2016 to December 31, 2018. Initial viral load, CD4+ T cell count, issuance of an electronic prescription (e-script), subsequent viral loads until suppressed and patient demographics were collected for each individual seen in clinic during the review period. Viral suppression was defined as a viral load less than 200 copies/mL. Rapid ART initiation was defined as receiving an e-script for antiretrovirals within seven days of diagnosis. Results Between January 1, 2016 and December 31, 2018, 70 individuals were diagnosed with HIV and presented to Open Arms Healthcare Center, of which 63 (90%) completed an initial HIV counseling visit. Twenty-seven percent of patients were provided with an e-script for ART within 7 days of diagnosis. The median time to linkage to care for this sample was 12 days and 5.5 days for rapid ART starters (p < 0.001). Median time from diagnosis to viral suppression was 55 days for rapid ART starters (p = 0.03), a 22 day decrease from standard time to viral suppression. Conclusion Our results provide a similar level of evidence that rapid ART initiation is effective in decreasing time to viral suppression. Evidence from this evaluation supports the use of rapid ART initiation after an initial HIV diagnosis, including same-day treatment.

scholarly journals 896. Examining the Impact of the COVID-19 Pandemic on Delivery of HIV Care and Prevention Services Among Patients in a Ryan White Clinic

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S539-S539
Author(s):  
Michelle Zhang ◽  
Sharlay Butler ◽  
Jason Kennedy ◽  
Molly McKune ◽  
Ghady Haidar ◽  
...  
Keyword(s):  
Viral Load ◽  
Viral Suppression ◽  
Retention In Care ◽  
Hiv Treatment ◽  
Hiv Care ◽  
Viral Load Suppression ◽  
Sti Prevention ◽  
Prevention Services ◽  
The Impact ◽  
Non Parametric

Abstract Background We sought to characterize the impact of the COVID-19 pandemic on HIV-related outcomes in a cohort of patients by examining rates of viral load (VL) suppression, retention-in-care, PrEP access, and STIs. Methods This was a single center, retrospective study of adults receiving HIV treatment or HIV/STI prevention services from 01/2019 - 12/2020. HIV outpatient visits were identified through HRSA’s CareWARE. Visits (in-person, telehealth) only included HIV primary care. HRSA core performance measures were utilized (Table 1). STI positivity rates and descriptive characteristics were calculated. New and refill PrEP prescriptions were tabulated. Chi-square tests compared unmatched non-parametric variables; McNemar’s test matched non-parametric variables. Multivariable logistic regression identified variables associated with retention in care and viral suppression. Results 1721 patients received care; 1234 were seen in both years, 334 only in 2019, 153 only in 2020. The number of telehealth visits increased significantly: video (0% to 31%, &lt; 0.001), phone (0% to 0.4%, p &lt; 0.001). Though the proportion of kept appointments increased (57.2% vs 61.2%), the annual retention in care rate decreased from 74.5% to 70.9% (p = 0.002). Overall, 9.7% of patients had detectable VLs at any point. Compared to 2019, a lower proportion of patients maintained VL suppression in 2020, (91.6% vs 83.5% p = 0.075). More patients did not have a VL drawn in 2020 than in 2019 (10.3% vs 2.0 %, p &lt; 0.001). Patients with detectable VLs in 2019 were more likely than those who were undetectable to have detectable VLs in 2020 (OR 18.2, 95% CI 9.91-33.42). Black race was associated with higher likelihood of lack of VL suppression (OR = 2.0; 95% CI 1.10-3.66). There were no significant differences between gender or age groups in rates of viral suppression, number screened for bacterial STIs or positive results. Visits for new and refill PrEP prescriptions decreased by 59% and 7%, respectively. Conclusion Rates of viral load suppression and retention in care decreased in 2020 compared to 2019. The proportion of clinic visits attended increased after the integration of telemedicine in 2020. These data may be used to inform evidence-based interventions to improve the HIV continuum of care through telehealth. Disclosures Ghady Haidar, MD, Karuys (Grant/Research Support)

scholarly journals Cost-effectiveness and Feasibility of Conditional Economic Incentives and Motivational Interviewing to Improve HIV Health Outcomes of Adolescents Living with HIV in Anambra State, Nigeria

2021 ◽  
Author(s):  
Obinna Ikechukwu Ekwunife ◽  
Chinelo Janefrances Ofomata ◽  
Charles Ebuka Okafor ◽  
Maureen Ugonwa Anetoh ◽  
Stephen Okorafor Kalu ◽  
...  
Keyword(s):  
Viral Load ◽  
Cost Effectiveness ◽  
Service Delivery ◽  
Motivational Interviewing ◽  
Undetectable Viral Load ◽  
Routine Care ◽  
Economic Incentives ◽  
Additional Patient ◽  
The Cost ◽  
The Impact

Abstract Background: In sub-Saharan Africa, there is increasing mortality and morbidity of adolescents due to poor linkage, retention in HIV care and adherence to antiretroviral therapy (ART). This is a result of limited adolescent-centred service delivery interventions. This cost-effectiveness and feasibility study were piggybacked on a cluster-randomized trial that assessed the impact of an adolescent-centred service delivery intervention. The service delivery intervention examined the impact of an incentive scheme consisting of conditional economic incentives and motivational interviewing on the health outcomes of adolescents living with HIV in Nigeria. Method: A cost-effectiveness analysis from the healthcare provider’s perspective was performed to assess the cost per additional patient achieving undetected viral load through the proposed intervention. The cost-effectiveness of the incentive scheme over routine care was estimated using the incremental cost-effectiveness ratio (ICER), expressed as cost/patient who achieved an undetectable viral load. A one-way sensitivity analysis examined the effect of the regimen change to Dolutegravir-based combination (which occurred during the trial) on the ICER. An in-depth interview was conducted on the healthcare personnel in the intervention arm to explore the feasibility of implementing the service delivery intervention in HIV treatment hospitals in Nigeria.Result: The ICER of the intervention compared to routine care was US$1,593.2 per additional patient with undetectable viral load. Going by the cost-effectiveness threshold suggested by the World Health Organization (WHO) Commission on Macroeconomics and Health, the intervention was very cost-effective as it costs less than one Nigerian GDP/capita of US$2028.2. The effect of regimen change increased the ICER to US$2,094.38. Healthcare professionals reported that patients’ acceptance of the intervention was very high.Conclusion: The conditional economic incentives and motivational interviewing were very cost-effective. Patients’ acceptance of the intervention was very high. However, healthcare professionals believed that sustaining the intervention may be difficult unless factors such as government commitment and healthcare provider diligence are duly addressed.Trial registration This trial is registered in the WHO International Clinical Trials Registry through the WHO International Registry Network (https://pactr.samrc.ac.za/: PACTR201806003040425).

scholarly journals STING and cGAS gene expressions were downregulated among HIV-1-infected persons after antiretroviral therapy

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Lorena Leticia Peixoto de Lima ◽  
Allysson Quintino Tenório de Oliveira ◽  
Tuane Carolina Ferreira Moura ◽  
Ednelza da Silva Graça Amoras ◽  
Sandra Souza Lima ◽  
...  
Keyword(s):  
Gene Expression ◽  
Viral Load ◽  
T Cell ◽  
Antiretroviral Therapy ◽  
Cell Count ◽  
Enzyme Linked Immunosorbent Assay ◽  
Type I ◽  
Α Level ◽  
The Impact ◽  
Hiv 1

Abstract Background The HIV-1 epidemic is still considered a global public health problem, but great advances have been made in fighting it by antiretroviral therapy (ART). ART has a considerable impact on viral replication and host immunity. The production of type I interferon (IFN) is key to the innate immune response to viral infections. The STING and cGAS proteins have proven roles in the antiviral cascade. The present study aimed to evaluate the impact of ART on innate immunity, which was represented by STING and cGAS gene expression and plasma IFN-α level. Methods This cohort study evaluated a group of 33 individuals who were initially naïve to therapy and who were treated at a reference center and reassessed 12 months after starting ART. Gene expression levels and viral load were evaluated by real-time PCR, CD4+ and CD8+ T lymphocyte counts by flow cytometry, and IFN-α level by enzyme-linked immunosorbent assay. Results From before to after ART, the CD4+ T cell count and the CD4+/CD8+ ratio significantly increased (p < 0.0001), the CD8+ T cell count slightly decreased, and viral load decreased to undetectable levels in most of the group (84.85%). The expression of STING and cGAS significantly decreased (p = 0.0034 and p = 0.0001, respectively) after the use of ART, but IFN-α did not (p = 0.1558). Among the markers evaluated, the only markers that showed a correlation with each other were STING and CD4+ T at the time of the first collection. Conclusions ART provided immune recovery and viral suppression to the studied group and indirectly downregulated the STING and cGAS genes. In contrast, ART did not influence IFN-α. The expression of STING and cGAS was not correlated with the plasma level of IFN-α, which suggests that there is another pathway regulating this cytokine in addition to the STING–cGAS pathway.

scholarly journals Impact of a child -friendly clinic on retention of HIV-infected children in care: an intervention study

1970 ◽  
Vol 44 (4) ◽  
pp. 175-179
Author(s):  
OR Ugwu
Keyword(s):  
Highly Active Antiretroviral Therapy ◽  
Retention Rate ◽  
Retention In Care ◽  
Hiv Care ◽  
Satisfaction Survey ◽  
Loss To Follow Up ◽  
Child Friendly ◽  
Children In Care ◽  
The Impact

Background: Certain researchers have reported that a child-friendly clinic may improve patient/caregiver satisfaction at clinic attendance. This could serve as an innovation for reducing loss-to-follow up and increasing retention in care.Aim: To assess the impact of making the clinic more child-friendly on clinic experience, retention in care and loss-to-follow up of HIV -infected children.Method: The study was carried out in three phases. Phase one was a satisfaction survey to find out the patient/caregivers’ satisfaction of the clinic environment and services provided using a selfadministered questionnaire. Phase two was the creation of the childfriendly environment and phase three was a post-provision of child-friendly clinic satisfaction survey. The loss-to-follow up rate (failure to return to clinic ≥3months after the last scheduled clinic appointment in a child not known to be dead or transferred out of the facility) and retention rate (remaining alive and receiving highly active antiretroviral therapy) were also determined before and after setting up the childfriendly clinic.Results: There were 146 respondents before the study and 206 respondents after the intervention. The retention rate increased from 62.5% to 82% (p=0.02), while the loss-to-follow up rate dropped from 27.7% to 7.0% (p=0.00).Conclusion: Making the clinic area child-friendly can impact greatly on HIV care by improving patient satisfaction and retention of HIVinfected children in care and reducing loss-to-follow up.Key words: HIV, child-friendly environment, retention in care, loss to follow-up.

scholarly journals The impact of an integrated depression and HIV treatment program on mental health and HIV care outcomes among people newly initiating antiretroviral therapy in Malawi

PLoS ONE ◽  
2020 ◽  
Vol 15 (5) ◽  
pp. e0231872 ◽  
Author(s):  
Melissa A. Stockton ◽  
Michael Udedi ◽  
Kazione Kulisewa ◽  
Mina C. Hosseinipour ◽  
Bradley N. Gaynes ◽  
...  
Keyword(s):  
Mental Health ◽  
Antiretroviral Therapy ◽  
Treatment Program ◽  
Hiv Treatment ◽  
Hiv Care ◽  
Care Outcomes ◽  
The Impact

scholarly journals Delivery of HIV Antiretroviral Therapy Adherence Support Services by HIV Care Providers in the United States, 2013 to 2014

2017 ◽  
Vol 16 (6) ◽  
pp. 624-631 ◽  
Author(s):  
John Weiser ◽  
Linda Beer ◽  
John T. Brooks ◽  
Kathleen Irwin ◽  
Brady T. West ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Nurse Practitioners ◽  
Support Services ◽  
International Association ◽  
The United States ◽  
Hiv Care ◽  
Art Adherence ◽  
Care Providers ◽  
Adherence Support ◽  
Hiv Antiretroviral Therapy

Background: Little is known about clinicians’ adoption of recommendations of the International Association of Providers of AIDS Care and others for supporting adherence to antiretroviral therapy (ART). Methods: We surveyed a probability sample of US HIV care providers to estimate the percentage offering 3 ART adherence support services to most or all patients and assessed the characteristics of providers offering all 3 services (comprehensive support) to most or all patients. Results: Almost all providers (95.5%) discussed ART adherence at every visit, 60.1% offered advice about tools to increase adherence, 53.5% referred nonadherent patients for supportive services, and 42.8% provided comprehensive support. Nurse practitioners were more likely to offer comprehensive support as were providers who practiced at Ryan White HIV/AIDS Program-funded facilities, provided primary care, or started caring for HIV-infected patients within 10 years. Conclusion: Less than half of HIV care providers offered comprehensive ART adherence support. Certain subgroups may benefit from interventions to increase delivery of adherence support.

scholarly journals The HIV care cascade for adolescents initiated on antiretroviral therapy in a health district of South Africa: a retrospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Roxanna Haghighat ◽  
Elona Toska ◽  
Nontuthuzelo Bungane ◽  
Lucie Cluver
Keyword(s):  
South Africa ◽  
Viral Load ◽  
Antiretroviral Therapy ◽  
Viral Suppression ◽  
Hiv Care ◽  
Loss To Follow Up ◽  
Hiv Care Cascade ◽  
Care Cascade ◽  
Clinical Records

Abstract Background Little evidence exists to comprehensively estimate adolescent viral suppression after initiation on antiretroviral therapy in sub-Saharan Africa. This study examines adolescent progression along the HIV care cascade to viral suppression for adolescents initiated on antiretroviral therapy in South Africa. Methods All adolescents ever initiated on antiretroviral therapy (n=1080) by 2015 in a health district of the Eastern Cape, South Africa, were interviewed in 2014–2015. Clinical records were extracted from 52 healthcare facilities through January 2018 (including records in multiple facilities). Mortality and loss to follow-up rates were corrected for transfers. Predictors of progression through the HIV care cascade were tested using sequential multivariable logistic regressions. Predicted probabilities for the effects of significant predictors were estimated by sex and mode of infection. Results Corrected mortality and loss to follow-up rates were 3.3 and 16.9%, respectively. Among adolescents with clinical records, 92.3% had ≥1 viral load, but only 51.1% of viral loads were from the past 12 months. Adolescents on ART for ≥2 years (AOR 3.42 [95%CI 2.14–5.47], p< 0.001) and who experienced decentralised care (AOR 1.39 [95%CI 1.06–1.83], p=0.018) were more likely to have a recent viral load. The average effect of decentralised care on recent viral load was greater for female (AOR 2.39 [95%CI 1.29–4.43], p=0.006) and sexually infected adolescents (AOR 3.48 [95%CI 1.04–11.65], p=0.043). Of the total cohort, 47.5% were recorded as fully virally suppressed at most recent test. Only 23.2% were recorded as fully virally suppressed within the past 12 months. Younger adolescents (AOR 1.39 [95%CI 1.06–1.82], p=0.017) and those on ART for ≥2 years (AOR 1.70 [95%CI 1.12–2.58], p=0.013) were more likely to be fully viral suppressed. Conclusions Viral load recording and viral suppression rates remain low for ART-initiated adolescents in South Africa. Improved outcomes for this population require stronger engagement in care and viral load monitoring.

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