13 research outputs found
Psychosocial support interventions for improved adherence and retention in ART care for young people living with HIV (10–24 years): a scoping review
Mental health disorders such as high levels of anxiety, isolation, depression and suicide ideation
reported among young people living with HIV (10–24 years;YPLHIV) contribute significantly to poor medication
adherence and retention in care. While there is evidence supporting the role of psychosocial support interventions
in promoting adherence and retention in antiretroviral treatment (ART) among adults living with HIV, there is little
evidence on the role of psychosocial support on medication adherence among YPLHIV. This scoping review was
designed to identify and classify the types and effects of psychosocial support interventions designed to improve
adherence and retention in ART among YPLHIV globally
Desperate times call for desperate measures: Adapting antiretroviral service delivery in the context of the COVID-19 pandemic
On 23 March 2020, President Cyril Ramaphosa
announced a nation-wide lockdown to help curb the spread of the
COVID-19 epidemic in South Africa (SA). While these containment
measures are considered to have limited the spread of COVID-19 in
SA, the economic and social consequences, including the impact on
healthcare service delivery, are prominent.
Regarding healthcare service delivery, there are concerns about
people who could be at risk of experiencing severe COVID-19
infection, and about meeting the needs of people with chronic
diseases such as people living with HIV (PLHIV). In the context of
the COVID-19 pandemic, PLHIV with an unsuppressed viral load
may be at increased risk of developing severe COVID-19-related
conditions and potentially dying, especially those who are co-infected
with tuberculosis (TB)
Two-year retention in care for adolescents on antiretroviral therapy in Ehlanzeni district, South Africa: a baseline cohort analysis
Adolescents living with HIV (ALHIV) struggle to remain engaged in HIV-related care and adhere to
antiretroviral treatment (ART) due to a myriad of physical, psychological and cognitivedevelopmental challenges. We report on the profile of ALHIV aged 10–19 years on ART and the
clinical factors associated with their retention in care. A retrospective cohort analysis was
conducted with 16,108 ALHIV, aged 10–19 years, who were enrolled in 136 ART clinics in the
Ehlanzeni district. Anonymised data were obtained from electronic medical records (Tier.net).
Trends in retention in care among adolescents on ART was described using Kaplan-Meier
survival estimates. Cox proportional analysis was performed to identify factors associated with
retention in care over 2 years. More than half (53%) were females, and median duration on ART
was 8 months. Retention in care among adolescents at months 6, 12, 18 and 24 was 90.5%,
85.4%, 80.8% and 76.2%, respectively. After controlling for confounders, risk of dying or lost to
follow up increased for female adolescents (aHR = 1.28, 95% CI 1.10–1.49); being initiated on
ART while pregnant (aHR = 2.72, 95% CI 1.99–3.69); history of TB infection (aHR = 1.71, 95% CI
1.10–2.65); and started ART at age 10–14 years (aHR = 2.45, 95% CI 1.96–3.05), and 15–19 years
(aHR = 9.67, 95% CI 7.25–12.89). Retention in care among adolescents on ART over two-year
period was considerably lower than the UNAIDS 2030 target of 95%. Of particular concern for
intervention is the lower rates of retention in care among females and pregnant adolescents
and starting ART between the ages of 10 and 19 years. Family or caregivers and peer support
groups centred interventions designed to promote early initiation and retention in care through
early case identification are needed
Determinants of viral suppression among adolescents on antiretroviral treatment in Ehlanzeni district, South Africa: a cross-sectional analysis
Achieving undetectable viral load is crucial for the reduction of HIV transmissions, AIDS-related illnesses and death. Adolescents (10 to19 years) living with HIV (ALHIV) on antiretroviral treatment (ART) have worse
treatment adherence and lower viral suppression rates compared to adults. We report on the clinical factors associated with viral suppression among ALHIV in the Ehlanzeni district, Mpumalanga in South Africa.A cross-sectional analysis was conducted with 9386 ALHIV, aged 10 to 19 years, who were enrolled in 136
ART clinics in the Ehlanzeni district. Clinical and immunological data were obtained from electronic medical records
(Tier.net). ALHIV were categorised as having achieved viral suppression if their latest viral load count was<1000
ribonucleic acid (RNA) copies/mL. Using a backward stepwise approach, a multivariate logistic regression analysis was
performed to identify factors independently associated with viral suppression
Unearthing how, why, for whom and under what health system conditions the antiretroviral treatment adherence club intervention in South Africa works: A realist theory refining approach
BACKGROUND: Poor retention in care and suboptimal adherence to antiretroviral treatment (ART) undermine its
successful rollout in South Africa. The adherence club intervention was designed as an adherence-enhancing
intervention to enhance the retention in care of patients on ART and their adherence to medication. Although
empirical evidence suggests the effective superiority of the adherence club intervention to standard clinic ART care
schemes, it is poorly understood exactly how and why it works, and under what health system contexts. To this
end, we aimed to develop a refined programme theory explicating how, why, for whom and under what health
system contexts the adherence club intervention works (or not).
METHODS: We undertook a realist evaluation study to uncover the programme theory of the adherence club
intervention. We elicited an initial programme theory of the adherence club intervention and tested the initial
programme theory in three contrastive sites. Using a cross-case analysis approach, we delineated the conceptualisation
of the intervention, context, actor and mechanism components of the three contrastive cases to explain the outcomes
of the adherence club intervention, guided by retroductive inferencing.
RESULTS: We found that an intervention that groups clinically stable patients on ART in a convenient space to receive a
quick and uninterrupted supply of medication, health talks, counselling, and immediate access to a clinician when
required works because patients’ self-efficacy improves and they become motivated and nudged to remain in care and
adhere to medication. The successful implementation and rollout of the adherence club intervention are contingent
on the separation of the adherence club programme from other patients who are HIV-negative. In addition, there
should be available convenient space for the adherence club meetings, continuous support of the adherence club
facilitators by clinicians and buy-in from the health workers at the health-care facility and the community.
CONCLUSION: Understanding what aspects of antiretroviral club intervention works, for what sections of the patient
population, and under which community and health systems contexts, could inform guidelines for effective
implementation in different contexts and scaling up of the intervention to improve population-level ART adherence
A realist approach to eliciting the initial programme theory of the antiretroviral treatment adherence club intervention in the Western Cape Province, South Africa
BACKGROUND: The successful initiation of people living with HIV/AIDS on antiretroviral therapy (ART) in South Africa has
engendered challenges of poor retention in care and suboptimal adherence to medication. The adherence club
intervention was implemented in the Metropolitan area of the Western Cape Province to address these challenges. The
adherence club programme has shown potential to relieve clinic congestion, improve retention in care and
enhance treatment adherence in the context of rapidly growing HIV patient populations being initiated on ART.
Nevertheless, how and why the adherence club intervention works is not clearly understood. We aimed to elicit an
initial programme theory as the first phase of the realist evaluation of the adherence club intervention in the Western
Cape Province.
METHODS: The realist evaluation approach guided the elicitation study. First, information was obtained from an exploratory
qualitative study of programme designers’ and managers’ assumptions of the intervention. Second, a document review of
the design, rollout, implementation and outcome of the adherence clubs followed. Third, a systematic review of available
studies on group-based ART adherence support models in Sub-Saharan Africa was done, and finally, a scoping review of
social, cognitive and behavioural theories that have been applied to explain adherence to ART. We used the
realist evaluation heuristic tool (Intervention-context-actors-mechanism-outcome) to synthesise information from the
sources into a configurational map. The configurational mapping, alignment of a specific combination of attributes,
was based on the generative causality logic – retroduction.
RESULTS: We identified two alternative theories: The first theory supposes that patients become encouraged,
empowered and motivated, through the adherence club intervention to remain in care and adhere to the treatment.
The second theory suggests that stable patients on ART are being nudged through club rules and regulations
to remain in care and adhere to the treatment with the goal to decongest the primary health care facilities.
CONCLUSION: The initial programme theory describes how (dynamics) and why (theories) the adherence club
intervention is expected to work. By testing theories in “real intervention cases” using the realist evaluation
approach, the theories can be modified, refuted and/or reconstructed to elicit a refined theory of how and
why the adherence club intervention works
What do the implementation outcome variables tell us about the scaling-up of the antiretroviral treatment adherence clubs in South Africa? A document review
Ambulanssjuksköterskors erfarenheter av att delta vid prehospitala förlossningar
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Exploring 'generative mechanisms' of the antiretroviral adherence club intervention using the realist approach: a scoping review of research-based antiretroviral treatment adherence theories
BACKGROUND: Poor retention in care and non-adherence to antiretroviral therapy (ART) continue to undermine the success of HIV treatment and care programmes across the world. There is a growing recognition that multifaceted interventions - application of two or more adherence-enhancing strategies - may be useful to improve ART adherence and retention in care among people living with HIV/AIDS. Empirical evidence shows that multifaceted interventions produce better results than interventions based on a singular perspective. Nevertheless, the bundle of mechanisms by which multifaceted interventions promote ART adherence are poorly understood. In this paper, we reviewed theories on ART adherence to identify candidate/potential mechanisms by which the adherence club intervention works. METHODS: We searched five electronic databases (PubMed, EBSCOhost, CINAHL, PsycARTICLES and Google Scholar) using Medical Subject Headings (MeSH) terms. A manual search of citations from the reference list of the studies identified from the electronic databases was also done. Twenty-six articles that adopted a theory-guided inquiry of antiretroviral adherence behaviour were included for the review. Eleven cognitive and behavioural theories underpinning these studies were explored. We examined each theory for possible 'generative causality' using the realist evaluation heuristic (Context-Mechanism-Outcome) configuration, then, we selected candidate mechanisms thematically. RESULTS: We identified three major sets of theories: Information-Motivation-Behaviour, Social Action Theory and Health Behaviour Model, which explain ART adherence. Although they show potential in explaining adherence bebahiours, they fall short in explaining exactly why and how the various elements they outline combine to explain positive or negative outcomes. Candidate mechanisms indentified were motivation, self-efficacy, perceived social support, empowerment, perceived threat, perceived benefits and perceived barriers. Although these candidate mechanisms have been distilled from theories employed to explore adherence to ART in various studies, the theories by themselves do not provide an explanatory model of adherence based on the realist logic. CONCLUSIONS: The identified theories and candidate mechanisms offer possible generative mechanisms to explain how and why patients adhere (or not) to antiretroviral therapy. The study provides crucial insights to understanding how and why multifaceted adherence-enhancing interventions work (or not). These findings have implications for eliciting programme theories of group-based adherence interventions such as the adherence club intervention.IS