scholarly journals Couples-focused intervention to improve engagement in HIV care: protocol for a randomised controlled trial

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e037468
Author(s):  
Alyssa Paige Tabrisky ◽  
Lara S Coffin ◽  
David P Olem ◽  
Torsten B Neilands ◽  
Mallory O'Neill Johnson
Keyword(s):  
Viral Load ◽  
Medication Adherence ◽  
Clinical Outcomes ◽  
Virological Suppression ◽  
Hiv Care ◽  
Randomised Control Trial ◽  
Engagement In Care ◽  
Engagement In Hiv Care ◽  
Living With Hiv ◽  
Counselling Intervention

Introduction Advances in HIV treatment have proven to be effective in increasing virological suppression, thereby decreasing morbidity, and increasing survival. Medication adherence is an important factor in reducing viral load among people living with HIV (PLWH) and in the elimination of transmission of HIV to uninfected partners. Achieving optimal medication adherence involves individuals taking their medications every day or as prescribed by their provider. However, not all PLWH in the USA are engaged in care, and only a minority have achieved suppressed viral load (viral load that is lower than the detectable limit of the assay). Sexual and gender minorities (SGM; those who do not identify as heterosexual or those who do not identify as the sex they were assigned at birth) represent a high-risk population for poor clinical outcomes and increased risk of HIV transmission, as they face barriers that can prevent optimal engagement in HIV care. Research in dyadic support, specifically within primary romantic partnerships, offers a promising avenue to improving engagement in care and treatment outcomes among SGM couples. Dyadic interventions, especially focused on primary romantic partnerships, have the potential to have a sustained impact after the structured intervention ends. Methods and analysis This paper describes the protocol for a randomised control trial of a theory-grounded, piloted intervention (DuoPACT) that cultivates and leverages the inherent sources of support within primary romantic relationships to improve engagement in HIV care and thus clinical outcomes among persons who are living with HIV and who identify as SGM (or their partners). Eligible participants must report being in a primary romantic relationship for at least 3 months, speak English, at least one partner must identify as a sexual or gender minority and at least one partner must be HIV+ with suboptimal engagement in HIV care, defined as less than excellent medication adherence, having not seen a provider in at least the past 8 months, having a detectable or unknown viral load or not currently on antiretroviral therapy. Eligible consenting couples are allocated equally to the two study arms: a structured six-session couples counselling intervention (DuoPACT) or a three-session individually-delivered HIV adherence counselling intervention (LifeSteps). The primary aim is to evaluate the efficacy of DuoPACT on virological suppression among HIV+ members of SGM couples with suboptimal engagement in care. The DuoPACT study began its target enrolment of 150 couples (300 individuals) in August 2017, and will continue to enrol until June 2021. Ethics and dissemination All procedures are approved by the Institutional Review Board at the University of California, San Francisco. Written informed consent is obtained from all participants at enrolment, and study progress is reviewed twice yearly by an external Safety Monitoring Committee. Dissemination activities will include formal publications and report back sessions with the community. Trial registration number NCT02925949; Pre-results.

scholarly journals Telehealth and texting intervention to improve HIV care engagement, mental health and substance use outcomes in youth living with HIV: a pilot feasibility and acceptability study protocol

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e028522 ◽  
Author(s):  
Angie R Wootton ◽  
Dominique A Legnitto ◽  
Valerie A Gruber ◽  
Carol Dawson-Rose ◽  
Torsten B Neilands ◽  
...  
Keyword(s):  
Mental Health ◽  
Substance Use ◽  
Problem Solving ◽  
Clinical Outcomes ◽  
San Francisco ◽  
Text Messages ◽  
Hiv Care ◽  
Engagement In Care ◽  
Study Staff ◽  
Living With Hiv

IntroductionYouth and young adults living with HIV (YLWH) experience worse clinical outcomes than adults and high rates of behavioural health challenges that impact their engagement in care and adherence to antiretroviral therapy. This study in the San Francisco Bay area aims to evaluate the feasibility, acceptability and preliminary clinical outcomes of a 12-session telehealth counselling series provided to 80 YLWH, including education, motivational enhancement and problem-solving around HIV care, mental health, substance use and other challenges. Findings will provide information about benefits and challenges of telehealth counselling for YLWH and will guide the development of new technology-based strategies for care.Methods and analysisThe Youth to Telehealth and Text to Improve Engagement in Care study is a pilot randomised, crossover trial examining the feasibility and acceptability of a telehealth counselling intervention consisting of twelve 20–30 min weekly sessions focused on identifying and problem-solving around barriers to HIV care access and adherence and on addressing mental health, substance use and/or other issues. Participants also receive text messages for check-ins, appointment reminders and to improve engagement. Participants complete quantitative online surveys at baseline, 4 and 8 months and qualitative exit interviews. Clinical outcomes, including plasma HIV RNA and CD4+ cell count, are collected from medical records. Study staff will explore outcomes of the intervention using quantitative and qualitative methods.Ethics and disseminationThis study and its protocols have been approved by the University of California, San Francisco (UCSF) Institutional Review Board. Study staff will work with the UCSF Center for AIDS Prevention Studies’ Community Engagement Core and the Youth Advisory Panel to disseminate results to the community, participants and the academic community.Trial registrationNCT03681145.

scholarly journals An Exploration of Syndemic Factors That Influence Engagement in HIV Care Among Black Men

2018 ◽  
Vol 28 (7) ◽  
pp. 1077-1087 ◽  
Author(s):  
Katherine G. Quinn ◽  
Sarah J. Reed ◽  
Julia Dickson-Gomez ◽  
Jeffrey A. Kelly
Keyword(s):  
Black Men ◽  
Hiv Treatment ◽  
Hiv Care ◽  
Structural Level ◽  
Engagement In Care ◽  
Treatment Interventions ◽  
Engagement In Hiv Care ◽  
Living With Hiv ◽  
Syndemic Theory ◽  
Study Offer

Syndemic theory seeks to understand the interactions and clustering of disease and social conditions and explain racial disparities in HIV. Traditionally applied to HIV risk, this study characterizes the syndemic challenges of engagement in care among Black men living with HIV and provides insight into potential HIV treatment interventions to retain vulnerable individuals in care. Interviews were conducted with 23 HIV-positive men who were either out-of-care or nonadherent to antiretroviral therapy (ART). Interviews were audio recorded, transcribed verbatim, and coded using MAXQDA qualitative software. Researchers analyzed data using thematic content analysis to identify syndemic factors associated with disengagement in care or suboptimal ART adherence among Black men. Analyses revealed the syndemic nature of four themes: intersectional stigma, depression, substance use, and poverty. Findings from this study offer numerous opportunities for intervention including social and structural-level interventions to address syndemic processes and the influence of stigma and poverty on engagement in care.

scholarly journals WYZ: a pilot study protocol for designing and developing a mobile health application for engagement in HIV care and medication adherence in youth and young adults living with HIV

BMJ Open ◽  
2019 ◽  
Vol 9 (5) ◽  
pp. e030473 ◽  
Author(s):  
Xavier A. Erguera ◽  
Mallory O. Johnson ◽  
Torsten B. Neilands ◽  
Theodore Ruel ◽  
Beth Berrean ◽  
...  
Keyword(s):  
Young Adults ◽  
Medication Adherence ◽  
San Francisco ◽  
Mobile Health ◽  
Hiv Care ◽  
Mobile Health Application ◽  
Study Staff ◽  
Youth And Young Adults ◽  
Engagement In Hiv Care ◽  
Living With Hiv

IntroductionYouth and young adults bear a disproportionate share of the HIV burden and there is a critical need for interventions to curb health disparities experienced among these age groups. The purpose of our research is to build on our theory-guided model and formative research to develop a mobile health application, called WYZ, for improved engagement in HIV care and antiretroviral therapy adherence, and pilot test it among youth and young adults living with HIV (YLWH). In this paper, we explain the design and development of WYZ for YLWH, describe the design of a forthcoming pilot trial for evaluating the feasibility and acceptability of WYZ and compare WYZ with other mobile health applications being developed to improve engagement in HIV care and antiretroviral medication adherence.Methods and analysisWe used an agile methodology, shown to be useful in software development, and elicited feedback during beta testing to develop WYZ. WYZ is a modular, adaptive and personalised intervention delivered via a mobile phone. It is grounded in the information, motivation, behaviouralskills model which has been valuable for understanding and guiding the development of interventions for complex health behaviours. WYZ was created in collaboration with YLWH aged 18–29 years using a human-centred design approach that emphasises understanding the perspective of the users of the technology. WYZ is intended to improve engagement in HIV care by: (1) enhancing medication adherence self-efficacy, (2) increasing awareness and use of community resources, (3) reducing barriers to communication between youth and their healthcare team, and (4) providing a secure platform for the formation of a private online community of YLWH. We will conduct a 6-month single-arm pilot study to examine feasibility and acceptability of WYZ among 76 YLWH who live or receive care in the San Francisco Bay Area. All study activities, including recruitment, screening, enrolment, study assessments, provision of incentives and exit interviews, will be conducted remotely. We will explore feasibility and acceptability outcomes of the intervention using quantitative and qualitative methods.Ethics and disseminationStudy staff will obtain written consent for study participation from all participants. This study and its protocols have been approved by the University of California San Francisco (UCSF) Institutional Review Board. Study staff will work with the UCSF Center for AIDS Prevention Studies’ Community Engagement Core and the Youth Advisory Panel to disseminate results to the participants and the community using presentations, community forums, journal publications and/or social media.Trial registration numberNCT03587857; Pre-results.

Utility and acceptability of text messages for PMTCT: a qualitative assessment of user experiences (Preprint)

2021 ◽  
Author(s):  
Melinda Brown ◽  
May Maloba ◽  
Catherine Wexler ◽  
Natabhona Mabachi ◽  
Sharon Koech ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Pilot Study ◽  
Clinical Care ◽  
Text Messages ◽  
Hiv Care ◽  
Qualitative Assessment ◽  
Women Living With Hiv ◽  
Pregnancy And Postpartum ◽  
Living With Hiv ◽  
The Impact

BACKGROUND Evidence that text messages can support patient adherence to HIV care is growing. We conducted a pilot study of the HIV Infant Tracking System (HITSystem 2.0), an intervention that includes SMS to patients to support maternal medication adherence, appointment attendance, and hospital-based deliveries during the antenatal period. OBJECTIVE The objective of this study was to qualitatively assess women’s experiences receiving SMS to understand message utility and acceptability with the goal of refining and strengthening the intervention. METHODS As part of an intervention development pilot study, we conducted semi-structured interviews with 33 women living with HIV who received SMS through the HITSystem 2.0 throughout their pregnancy and postpartum period. Interview questions assessed women’s feedback of the SMS, the impact of the SMS on their PMTCT care, and suggestions for improvement. RESULTS Participants described how SMS reinforced existing strategies for medication adherence and served as cues to action for antenatal appointments and hospital-based deliveries. SMS also provided encouragement and enhanced their sense of engagement with their clinical care team. Given the neutral content of the messages, most women reported no concerns about message confidentiality. Recommendations to enhance utility included greater customizability (timing and frequency of messages) and a few women suggested more comprehensive counseling regarding the SMS content to anticipate at the time of enrollment. CONCLUSIONS SMS content was deemed useful and acceptable by pregnant and postpartum women living with HIV and engaged in PMTCT services. Participant recommendations to increase message customization options have been adopted to enhance the intervention. CLINICALTRIAL Trial registration: clinicaltrials.gov, NCT02726607. Registered 01 April 2016. Retrospectively registered. https://clinicaltrials.gov/ct2/show/NCT02726607

scholarly journals Performance and Outcomes of Routine Viral Load Testing in People Living with HIV Newly Initiating ART in the Integrated HIV Care Program in Myanmar between January 2016 and December 2017

2020 ◽  
Vol 5 (3) ◽  
pp. 140
Author(s):  
Sai Soe Thu Ya ◽  
Anthony D. Harries ◽  
Khin Thet Wai ◽  
Nang Thu Thu Kyaw ◽  
Thet Ko Aung ◽  
...  
Keyword(s):  
Viral Load ◽  
Virologic Failure ◽  
Secondary Data ◽  
Care Program ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Second Line ◽  
Load Testing ◽  
One Year ◽  
Living With Hiv

Myanmar has introduced routine viral load (VL) testing for people living with HIV (PLHIV) starting first-line antiretroviral therapy (ART). The first VL test was initially scheduled at 12-months and one year later this changed to 6-months. Using routinely collected secondary data, we assessed program performance of routine VL testing at 12-months and 6-months in PLHIV starting ART in the Integrated HIV-Care Program, Myanmar, from January 2016 to December 2017. There were 7153 PLHIV scheduled for VL testing at 12-months and 1976 scheduled for VL testing at 6-months. Among those eligible for testing, the first VL test was performed in 3476 (51%) of the 12-month cohort and 952 (50%) of the 6-month cohort. In the 12-month cohort, 10% had VL > 1000 copies/mL, 79% had repeat VL tests, 42% had repeat VL > 1000 copies/mL (virologic failure) and 85% were switched to second-line ART. In the 6-month cohort, 11% had VL > 1000 copies/mL, 83% had repeat VL tests, 26% had repeat VL > 1000 copies/mL (virologic failure) and 39% were switched to second-line ART. In conclusion, half of PLHIV initiated on ART had VL testing as scheduled at 12-months or 6-months, but fewer PLHIV in the 6-month cohort were diagnosed with virologic failure and switched to second-line ART. Programmatic implications are discussed.

scholarly journals Uptake of routine viral load testing among people living with HIV and its implementation challenges in Yangon region of Myanmar: a mixed-methods study

BMJ Open ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. e032678
Author(s):  
Khine Khine Thinn ◽  
Pruthu Thekkur ◽  
Nang Thu Thu Kyaw ◽  
Nyein Su Aye ◽  
Tin Maung Zaw ◽  
...  
Keyword(s):  
Viral Load ◽  
Mixed Methods ◽  
Clinical Stage ◽  
Virological Suppression ◽  
Mixed Methods Study ◽  
People Living With Hiv ◽  
Sample Collection ◽  
Implementation Challenges ◽  
Wage Loss ◽  
Living With Hiv

ObjectivesIn 2017, Myanmar implemented routine viral load (VL) monitoring for assessing the response to antiretroviral therapy (ART) among people living with HIV (PLHIV). The performance of routine VL testing and implementation challenges has not yet assessed. We aimed to determine the uptake of VL testing and factors associated with it among PLHIV initiated on ART during 2017 in ART clinics of Yangon region and to explore the implementation challenges as perceived by the healthcare providers.DesignAn explanatory mixed-methods study was conducted. The quantitative component was a cohort study, and the qualitative part was a descriptive study with in-depth interviews.SettingSix ART clinics operated by AIDS/sexually transmitted infection teams under the National AIDS Programme.Primary outcome measures(1) The proportion who underwent VL testing by 30 March 2019 and the proportion with virological suppression (plasma VL <1000 copies/mL); (2) association between patient characteristics and ‘not tested’ was assessed using log binomial regression and (3) qualitative codes on implementation challenges.ResultsOf the 567 PLHIV started on ART, 498 (87.8%) retained in care for more than 6 months and were eligible for VL testing. 288 (57.8%, 95% CI: 53.3% to 62.2%) PLHIV underwent VL testing, of which 263 (91.3%, 95% CI: 87.1% to 94.4%) had virological suppression. PLHIV with WHO clinical stage 4 had significantly higher rates of ‘not being tested’ for VL. Collection of sample for VL testing only twice a month, difficulties in sample collection and transportation, limited trained workforce, wage loss and out-of-pocket expenditure for patients due to added visits were major implementation challenges.ConclusionsThe VL test uptake was low, with only six out of ten PLHIV tested. The VL testing uptake needs to be improved by strengthening sample collection and transportation, adopting point-of-care VL tests, increasing trained workforce, providing compensation to patients for wage loss and travel costs for additional visits.

scholarly journals Understanding Engagement in HIV Programmes: How Health Services Can Adapt to Ensure No One Is Left Behind

2020 ◽  
Vol 17 (5) ◽  
pp. 458-466
Author(s):  
Anna Grimsrud ◽  
Lynne Wilkinson ◽  
Ingrid Eshun-Wilson ◽  
Charles Holmes ◽  
Izukanji Sikazwe ◽  
...  
Keyword(s):  
Quality Care ◽  
Treatment Interruption ◽  
Patient Choice ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Engagement In Care ◽  
Hiv Status ◽  
Hiv Care Cascade ◽  
Left Behind ◽  
Living With Hiv

Abstract Purpose of Review Despite the significant progress in the HIV response, gaps remain in ensuring engagement in care to support life-long medication adherence and viral suppression. This review sought to describe the different points in the HIV care cascade where people living with HIV were not engaging and highlight promising interventions. Recent Findings There are opportunities to improve engagement both between testing and treatment and to support re-engagement in care for those in a treatment interruption. The gap between testing and treatment includes people who know their HIV status and people who do not know their status. People in a treatment interruption include those who interrupt immediately following initiation, early on in their treatment (first 6 months) and late (after 6 months or more on ART). For each of these groups, specific interventions are required to support improved engagement. Summary There are diverse needs and specific populations of people living with HIV who are not engaged in care, and differentiated service delivery interventions are required to meet their needs and expectations. For the HIV response to realise the 2030 targets, engagement will need to be supported by quality care and patient choice combined with empowered patients who are treatment literate and have been supported to improve self-management.

scholarly journals Are you suppressed? Viral load test coverage for people living with HIV in Mutare District, Manicaland Province, Zimbabwe, 2015-2017 Investigators

2018 ◽  
Author(s):  
Charles Uzande ◽  
Jeffery Edwards ◽  
Philip Owiti ◽  
Admire Tatenda Maravanyika ◽  
Simba Mashizha ◽  
...  
Keyword(s):  
Risk Factors ◽  
Viral Load ◽  
Electronic Monitoring ◽  
Significant Risk ◽  
Load Test ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Adjusted Relative Risk ◽  
Factors Associated ◽  
Living With Hiv

AbstractBackground:The third 90-90-90 UNAIDS goal require that 90% of people living with HIV (PLHIV) on antiretroviral treatment (ART) achieve viral load (VL) suppression. This study assessed the proportion of VL suppression and related factors among PLHIV on 1st and 2nd line ART in Mutare District, Manicaland Province, Zimbabwe between 2015-2017.Methods:A retrospective study using routine HIV programme data from the electronic monitoring system for nine health facilities in Mutare District. VL suppression was defined as < 1,000 copies/ml.Results:Of 16,590 registered patients, 15,566(94%) were on first-line and 1024(6%) on second-line ART. Of those on 1st-line ART, 2856(18%) had a VL test result documented, while 367(36%) of 2nd-line ART patients had VL results. VL suppression rates were 86% among those on 1st-line and 45% in 2nd-line ART. Independent risk factors associated with VL non-suppression for those on 1st-line ART were age 0-9 years (adjusted relative risk, aRR=2.9; 95% confidence interval, CI=1.7-4.8;P<0.001), 10-19 years (aRR=2.2;95%CI=1.4-3.2,P<0.001) compared to those 20-49 years, concurrent TB (aRR=9; CI=3.0-29.7,P<0.001) and male gender (aRR=1.5,95%CI=1.1-2.1;P=0.02). There were no significant risk factors associated with VL non-suppression for 2nd-line ART patients.Conclusion:For PLHIV on 1st-line ART in Mutare district, Manicaland, Zimbabwe, the frequency of reported VL results were only 18% among those on 1st-line ART, while the rate of VL suppression was near 90%. Viral Load testing coverage appears to be lagging behind current Zimbabwe goals and increased support is needed to improve the quality of HIV care and help reduce the threat of possible HIV drug resistance in the future.

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