Tailored mHealth intervention for improving treatment adherence for people living with HIV in Iran (HamRaah): protocol for a feasibility study and randomised pilot trial with a nested realist evaluation

IntroductionMiddle East and North Africa (MENA) has a rising rate of new HIV infections and AIDS-related mortality. Consistent adherence to antiretroviral therapy (ART) leads to viral suppression, preventing HIV transmission and treatment failure. mHealth interventions can improve ART adherence by providing tailored support and directing patients to existing healthcare services. HamRaah (Persian for ‘together-in-path’) is the first mHealth-based intervention in a MENA country and is designed to improve adherence through two-way mobile messaging for people recently diagnosed with HIV in Tehran, Iran. The objectives of this pilot randomised controlled trial (RCT) are to examine the feasibility, acceptability and preliminary effectiveness of HamRaah, and to develop an explanatory theory for any observed effects through a nested realist evaluation.MethodsA feasibility study and two-arm RCT of HamRaah, with an embedded realist evaluation will be conducted. Participants will be randomised 1:1 to HamRaah or routine care for a 6-month intervention. The initial effectiveness of HamRaah will be assessed through the primary outcome of self-reported ART adherence and several secondary outcomes: retention in care, CD4 count and viral suppression. A theory-driven realist evaluation framework will be used to develop an explanatory theory regarding what works, for whom, how and in what context.Ethics and disseminationThe study received ethical clearance from Tehran University of Medical Sciences Ethics Committee and Oxford Tropical Research Ethics Committee People living with HIV in Tehran and key country stakeholders in HIV policy and programming have been involved in the development of HamRaah and this pilot trial. Participants will provide informed consent prior to study enrolment. The results will be disseminated to all stakeholders and presented in peer-reviewed journal publications and conferences.Trial registration numberIRCT20100601004076N23; Pre-results.

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Importance of support groups to the health and well-being of vulnerable children and young people living with HIV: a case study of the Kids Clubs program in Haiti

BMC Health Services Research ◽

10.1186/s12913-021-06242-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Susan K. Settergren ◽

Robert Philippe ◽

Joanne St. Louis ◽

Nathaniel Segaren ◽

Sylvie Boisson ◽

...

Keyword(s):

Viral Load ◽

Medication Adherence ◽

Young People ◽

Support Groups ◽

Viral Suppression ◽

People Living With Hiv ◽

Art Adherence ◽

Vulnerable Children ◽

Children And Young People ◽

Living With Hiv

Abstract Background Although access to antiretroviral therapy (ART) among children and young people living with HIV has increased in recent years, adherence to medication and viral suppression remain challenges. Evidence of benefits of support groups is growing and reflects a range of models and approaches. Since 2014, hospital-linked psychosocial support groups for children and young people living with HIV, known as Kids Clubs, have been established throughout Haiti. The program provides safe spaces for them to meet with peers, supports medication adherence, delivers health and life skills education, and facilitates linkages with clinic visits and social services. This study describes program enrollment and participant engagement, ART adherence and viral suppression among participants, and other outcomes attributed to the program by participants, caregivers, and program implementers. Methods Our mixed methods study included quantitative analysis of program monitoring data on rollout and attendance, and medication adherence and viral load results extracted from medical records. We collected qualitative data from club members, caregivers, and implementers about their experiences with the clubs and the impact of participation. Results From January 2014–December 2018, 1330 individuals aged 8–29 were enrolled in the program; over three-quarters participated for at least 12 months. In 2018, 1038 members attended at least one club meeting; more than half missed three or fewer monthly meetings. Three-quarters of ever-enrolled members reported consistent medication use at their most recent clinic visit; 64.2% (600/935) of those with a recent viral load test were virally suppressed. Level of club attendance was positively associated with ART adherence (p < 0.01) and viral suppression (p < 0.05). Club members, caregivers, and implementers noted the value of the clubs to participants’ retention in care and medication adherence, health knowledge, and capacity to deal with peer pressure, stigma, shyness, and depression. Conclusions The Kids Club program has been successful in scaling HIV support services to highly vulnerable children and young people through peer-based groups, and program participation has led to a range of benefits. Efforts to innovate, evaluate, and scale support strategies for vulnerable young populations must be accelerated in order to ensure that they survive, thrive, and reach their full potential.

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Healthcare Utilization, Unmet Service Needs, and Medication Adherence Among People Living with HIV/AIDS

Current HIV Research ◽

10.2174/1570162x18666200817112255 ◽

2020 ◽

Vol 18 (6) ◽

pp. 436-442

Author(s):

Xiangjun Zhang ◽

Roy F. Oman ◽

Trudy A. Larson ◽

Elizabeth J. Christiansen ◽

Michelle L. Granner ◽

...

Keyword(s):

Health Promotion ◽

Service Utilization ◽

Medical Service ◽

Outcome Variable ◽

People Living With Hiv ◽

Service Needs ◽

Art Adherence ◽

Living With Hiv ◽

Adherence Group ◽

Hiv Aids

Background: Comorbidity rates and service needs are high among people living with HIV/AIDS (PLWHA). The effects of service utilization and unmet service needs on antiretroviral therapy (ART) adherence are not well understood. The purpose of this study was to investigate associations among PLWHA’s service utilization, unmet service needs, and ART adherence. Methods: PLWHA (N=162) 18 years or older were recruited from a Nevada statewide needs assessment project in 2016. Participants completed a self-administered questionnaire on paper or online. The independent variables were service utilization and unmet service needs. The outcome variable was ART adherence. Multivariable logistic regression analyses were conducted to examine associations between the amount of utilized services and unmet service needs with ART adherence. Results: Only 12 (7.5%) participants reported they received all needed services. The ART non-adherence group showed significantly higher unmet medical service needs compared to the ART adherence group (p=0.007). Unmet medical service needs (Adjusted Odds Ratio (AOR) 0.69, CI 0.53-0.90) and unmet support service needs (AOR 0.68, CI 0.48-0.97) were negatively associated with ART adherence. However, utilizing medical services (AOR 1.06, CI 0.87-1.30) and support services (AOR 0.88, CI 0.74-1.04) in the current year were not significantly associated with ART adherence. Conclusion: The results of this study indicate that health promotion programming should focus not only on introducing new services at the community level, but also work to optimize the availability and awareness of current services. Furthermore, health promotion programs should focus on filling service coverage gaps and improving the facilitation of services.

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Antiretroviral Drugs Impact Autophagy with Toxic Outcomes

Cells ◽

10.3390/cells10040909 ◽

2021 ◽

Vol 10 (4) ◽

pp. 909

Author(s):

Laura Cheney ◽

John M. Barbaro ◽

Joan W. Berman

Keyword(s):

Quality Control ◽

Antiretroviral Therapy ◽

Side Effects ◽

Viral Suppression ◽

Antiretroviral Drugs ◽

People Living With Hiv ◽

Foreign Material ◽

Complete Understanding ◽

Living With Hiv ◽

Target Effects

Antiretroviral drugs have dramatically improved the morbidity and mortality of people living with HIV (PLWH). While current antiretroviral therapy (ART) regimens are generally well-tolerated, risks for side effects and toxicity remain as PLWH must take life-long medications. Antiretroviral drugs impact autophagy, an intracellular proteolytic process that eliminates debris and foreign material, provides nutrients for metabolism, and performs quality control to maintain cell homeostasis. Toxicity and adverse events associated with antiretrovirals may be due, in part, to their impacts on autophagy. A more complete understanding of the effects on autophagy is essential for developing antiretroviral drugs with decreased off target effects, meaning those unrelated to viral suppression, to minimize toxicity for PLWH. This review summarizes the findings and highlights the gaps in our knowledge of the impacts of antiretroviral drugs on autophagy.

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Symptoms of common mental disorders and adherence to antiretroviral therapy among adults living with HIV in rural Zimbabwe: a cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2021-049824 ◽

2021 ◽

Vol 11 (7) ◽

pp. e049824

Author(s):

Andreas D Haas ◽

Cordelia Kunzekwenyika ◽

Stefanie Hossmann ◽

Josphat Manzero ◽

Janneke van Dijk ◽

...

Keyword(s):

Antiretroviral Therapy ◽

Suicidal Ideation ◽

Mental Disorders ◽

Common Mental Disorders ◽

Cross Sectional Study ◽

People Living With Hiv ◽

Art Adherence ◽

Sectional Study ◽

Cross Sectional ◽

Living With Hiv

ObjectivesTo examine the proportion of people living with HIV who screen positive for common mental disorders (CMD) and the associations between CMD and self-reported adherence to antiretroviral therapy (ART).SettingSixteen government-funded health facilities in the rural Bikita district of Zimbabwe.DesignCross-sectional study.ParticipantsHIV-positive non-pregnant adults, aged 18 years or older, who lived in Bikita district and had received ART for at least 6 months.Outcome measuresThe primary outcome was the proportion of participants screening positive for CMD defined as a Shona Symptoms Questionnaire score of 9 or greater. Secondary outcomes were the proportion of participants reporting suicidal ideation, perceptual symptoms and suboptimal ART adherence and adjusted prevalence ratios (aPR) for factors associated with CMD, suicidal ideation, perceptual symptoms and suboptimal ART adherence.ResultsOut of 3480 adults, 18.8% (95% CI 14.8% to 23.7%) screened positive for CMD, 2.7% (95% CI 1.5% to 4.7%) reported suicidal ideations, and 1.5% (95% CI 0.9% to 2.6%) reported perceptual symptoms. Positive CMD screens were more common in women (aPR 1.67, 95% CI 1.19 to 2.35) than in men and were more common in adults aged 40–49 years (aPR 1.47, 95% CI 1.16 to 1.85) or aged 50–59 years (aPR 1.51, 95% CI 1.05 to 2.17) than in those 60 years or older. Positive CMD screen was associated with suboptimal adherence (aPR 1.53; 95% CI 1.37 to 1.70).ConclusionsA substantial proportion of people living with HIV in rural Zimbabwe are affected by CMD. There is a need to integrate mental health services and HIV programmes in rural Zimbabwe.Trial registration numberNCT03704805.

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Clinical situation of Venezuelan migrants living with HIV in a hospital in Lima, Peru

International Journal of STD & AIDS ◽

10.1177/09564624211024080 ◽

2021 ◽

pp. 095646242110240

Author(s):

Genesis S Huerta-Vera ◽

Manuel A Amarista ◽

Fernando A Mejía ◽

Ana B Graña ◽

Elsa V Gonzalez-Lagos ◽

...

Keyword(s):

Viral Suppression ◽

Clinical Situation ◽

Cross Sectional Study ◽

People Living With Hiv ◽

Sectional Study ◽

Cross Sectional ◽

Epidemiological Trends ◽

Clinical Conditions ◽

Living With Hiv

Due to a huge crisis extensive to health services many Venezuelan people living with HIV (PLWH) had migrated abroad, including Peru where favorable laws were in place until June 2019. We describe the health status and epidemiological trends of PLWH from Venezuela at an HIV program in Lima. We analyzed baseline and follow-up data of all Venezuelan PLWH enrolled in our HIV program from January 2017 to December 2019. A cross-sectional study in a subsample served to describe ARV adherence and context of migration. Between 2017-2019 our HIV Program registered 398 Venezuelan PLWH, representing 20% of the 2018 annual enrollments; numbers decreased since mid-2019. The median age was 30 years (IQR 26;37) and 90.5% were men. Between 2017 and 2019, the proportion with diagnosis in Peru increased from 14.3% to 60.9%; of AIDS stage at entry, from 8.8% to 27.2%. By December 2019, 182/250 (72.8%) were still in care, and 43 (10.8%) had not started ART. Viral suppression evaluated in 195, was achieved in 71.8%. From 2017 to 2019, migrant PLWH arrived in worsened clinical conditions, with increasing diagnosis in Peru; the flow of migrant PLWH entering care diminished with less favorable laws. Viral suppression rates were suboptimal.

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Predictive factors of ART adherence in people living with HIV in Guangxi, China: a retrospective cross-sectional study

AIDS Care ◽

10.1080/09540121.2021.1967851 ◽

2021 ◽

pp. 1-6

Author(s):

Jingzhen Lai ◽

Zhongsheng Jiang ◽

Hong Zhang ◽

Wudi Wei ◽

Xu Li ◽

...

Keyword(s):

Predictive Factors ◽

Cross Sectional Study ◽

People Living With Hiv ◽

Art Adherence ◽

Sectional Study ◽

Cross Sectional ◽

Living With Hiv

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Beyond viral suppression: the quality of life of people living with HIV in Sweden

AIDS Care ◽

10.1080/09540121.2018.1545990 ◽

2018 ◽

Vol 31 (4) ◽

pp. 403-412 ◽

Cited By ~ 6

Author(s):

Galit Zeluf-Andersson ◽

Lars E. Eriksson ◽

Lena Nilsson Schönnesson ◽

Jonas Höijer ◽

Peter Månehall ◽

...

Keyword(s):

Quality Of Life ◽

Viral Suppression ◽

People Living With Hiv ◽

Living With Hiv

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Call For Life, Uganda: Acceptability Of A Mobile Phone Support To Promote Adherence To Anti-Retroviral Therapy For Young Adults In A Randomised Control Trial: A Qualitative Review (Preprint)

10.2196/preprints.17418 ◽

2019 ◽

Author(s):

Agnes Bwanika Naggirinya

Keyword(s):

Human Immunodeficiency Virus ◽

Young Adults ◽

Mobile Phone ◽

Interactive Voice Response ◽

Text Messages ◽

Randomised Control Trial ◽

People Living With Hiv ◽

Art Adherence ◽

Immunodeficiency Virus ◽

Living With Hiv

BACKGROUND : Adherence to treatment is critical to obtain successful treatment outcomes. While factors influencing antiretroviral therapy (ART) adherence vary, young adults are less likely to adhere because of psychosocial issues such as stigma, ART-related side effects as well as lack of access to treatment. Call for Life mHealth tool (C4LU), is a mobile phone- based technology that provides text messages or Interactive Voice Response (IVR) functionalities, through a web-interface and offers four modules including pill reminders, clinic visit reminders, health tips and symptom self-reporting support. Within a randomised control trial, we assessed perspectives and experiences of young adults living with human immunodeficiency virus towards the C4LU- system, with the objective to improve ART adherence among young people living with HIV with help of mHealth tool. OBJECTIVE To improve ART adherence among young people living with HIV through use of mHealth tool. METHODS This was an exploratory qualitative design at two study sites nested within an open label randomized controlled trial (RCT) entitled: “Improving outcomes in human immunodeficiency virus (HIV) patients using mobile phone based interactive software support “Call for Life study A total of 600 participants were randomly assigned 1:1 to either Standard of Care (SoC)- face-to-face counsellor adherence support or SoC plus mHealth call for life system (C4LU). C4LU uses Interactive voice response or text messages delivered via mobile phone. The qualitative study explored perspectives and experiences of young adults (18-24 years) towards the mHealth tool “C4LU”. A purposive sample of twenty-one vulnerable youth, seventeen from the intervention and four from the SoC arm were selected. We used semi-structured interviews to facilitate an in-depth exploration of experiences of young adults regarding C4LU-System. Thirteen in-depth interviews and one focus group discussion were conducted. The young adults were from four categories of population of interest that were targeted to be offered specialised care: young adults on PMTCT, switching to / or on second line ART, positive partners in a discordant relationship and initiating 1st line ART. Data was managed using Nvivo version 11 and analysed thematically. RESULTS C4LU-mHealth tool was perceived as an acceptable intervention for young adults. While on the system, participants reported: improvement in medication adherence, strengthened doctor /clinician -patient relationships, increased health knowledge through educative health tips. Appointment reminders and symptom reporting were singled out as beneficial because the system would address and manage the problems of forgetfulness, and stigma related issues. CONCLUSIONS The system was described as an acceptable and feasible strategy to improve ART adherence and retention among young adults in resource limited settings CLINICALTRIAL Trial Registration: ClinicalTrials.gov NCT 02953080

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Multilevel of Factors Affected Optimal Adherence to Antiretroviral Therapy and Viral Suppression Amongst HIV-infected Prisoners in South Ethiopia: A Prospective Cohort Study

10.21203/rs.3.rs-627094/v1 ◽

2021 ◽

Author(s):

Terefe Gone Fuge ◽

George Tsourtos ◽

Emma R Miller

Keyword(s):

Cohort Study ◽

Antiretroviral Therapy ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Viral Suppression ◽

People Living With Hiv ◽

South Ethiopia ◽

Pharmacy Refill ◽

Living With Hiv ◽

Optimal Adherence

Abstract ObjectivesMaintaining optimal adherence and viral suppression in people living with HIV (PLWHA) is essential to ensure both preventative and therapeutic benefits of antiretroviral therapy (ART). Prisoners bear a particularly high burden of HIV infection and are highly likely to transmit to others during and after incarceration. However, the level of treatment adherence and viral suppression in incarcerated populations in low-income countries is unknown. This study aimed to determine the prevalence of non-adherence and viral failure, and contributing factors amongst prisoners in South Ethiopia. MethodsA prospective cohort study was conducted between June 1, 2019 and May 31, 2020 to compare the level of adherence and viral suppression between incarcerated and non-incarcerated PLWHA. The study involved 74 inmates living with HIV (ILWHA) and 296 non-incarcerated PLWHA. Background information (including sociodemographic, socioeconomic, psychosocial, behavioural, and incarceration related characteristics) was collected using a structured questionnaire. Adherence was determined based on the participants’ self-report and pharmacy refill records. Plasma viral load measurements undertaken within the study period were prospectively extracted to determine viral suppression. Univariate and multivariate regression models were used to analyse data. ResultsWhile prisoners had a significantly higher pharmacy refill adherence compared to non-incarcerated PLWHA (89% vs 75%), they had a slightly lower dose adherence (81% vs 83%). The prevalence of viral failure (VF) was also slightly higher (6%) in ILWHA compared to non-incarcerated PLWHA (4.4%). The overall dose non-adherence (NA) was significantly associated with missing ART appointments, level of satisfaction with ART services, patient’s ability to comply with a specified medication schedule and types of methods used to monitor the schedule. In ILWHA specifically, accessing ART services from a hospital compared to a health centre, an inability to always attend clinic appointments, experience of depression and a lack of social support predicted NA. VF was significantly higher in males, people of age 31to 35 years and in those who experienced social stigma, regardless of their incarceration status. ConclusionsThis study revealed that HIV-infected prisoners in South Ethiopia were more likely to be non-adherent to ART doses and to develop viral failure compared to their non-incarcerated counterparts. A multitude of factors were found to be responsible for this requiring multilevel intervention strategies focusing on the specific needs of prisoners.

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