Online citations, reference lists, and bibliographies.
Please confirm you are human
(Sign Up for free to never see this)
← Back to Search

Outcomes Of Patients Enrolled In An Antiretroviral Adherence Club With Recent Viral Suppression After Experiencing Elevated Viral Loads

J. Sharp, L. Wilkinson, V. Cox, Carol Cragg, G. van Cutsem, A. Grimsrud
Published 2019 · Medicine

Save to my Library
Download PDF
Analyze on Scholarcy
Share
Background Eligibility for differentiated antiretroviral therapy (ART) delivery models has to date been limited to low-risk stable patients. Objectives We examined the outcomes of patients who accessed their care and treatment through an ART adherence club (AC), a differentiated ART delivery model, immediately following receiving support to achieve viral suppression after experiencing elevated viral loads (VLs) at a high-burden ART clinic in Khayelitsha, South Africa. Methods Beginning in February 2012, patients with VLs above 400 copies/mL either on first- or second-line regimens received a structured intervention developed for patients at risk of treatment failure. Patients who successfully suppressed either on the same regimen or after regimen switch were offered immediate enrolment in an AC facilitated by a lay community health worker. We conducted a retrospective cohort analysis of patients who enrolled in an AC directly after receiving suppression support. We analysed outcomes (retention in care, retention in AC care and viral rebound) using Kaplan–Meier methods with follow-up from October 2012 to June 2015. Results A total of 165 patients were enrolled in an AC following suppression (81.8% female, median age 36.2 years). At the closure of the study, 119 patients (72.0%) were virally suppressed and 148 patients (89.0%) were retained in care. Six, 12 and 18 months after AC enrolment, retention in care was estimated at 98.0%, 95.0% and 89.0%, respectively. Viral suppression was estimated to be maintained by 90.0%, 84.0% and 75.0% of patients at 6, 12 and 18 months after AC enrolment, respectively. Conclusion Our findings suggest that patients who struggled to achieve or maintain viral suppression in routine clinic care can have good retention and viral suppression outcomes in ACs, a differentiated ART delivery model, following suppression support.
This paper references
10.1111/hiv.12284
A simple self‐reported adherence tool as a predictor of viral rebound in people with viral suppression on antiretroviral therapy
J. O'Connor (2016)
10.1371/journal.pone.0056088
Effectiveness of Patient Adherence Groups as a Model of Care for Stable Patients on Antiretroviral Therapy in Khayelitsha, Cape Town, South Africa
M. Luque-Fernandez (2013)
10.4102/SAJHIVMED.V14I2.77
ART adherence clubs: A long-term retention strategy for clinically stable patients receiving antiretroviral therapy
L. Wilkinson (2013)
10.1097/QAI.0b013e3182615ad1
Second-Line Antiretroviral Therapy: Long-Term Outcomes in South Africa
R. Murphy (2012)
AIDS statistics – 2018 fact sheet
HI UNAIDS. Global (2018)
10.1097/00002030-200404090-00006
Outcomes after two years of providing antiretroviral treatment in Khayelitsha, South Africa
D. Coetzee (2004)
10.1186/s12981-015-0077-4
Community-based ART distribution system can effectively facilitate long-term program retention and low-rates of death and virologic failure in rural Uganda
S. Okoboi (2015)
10.1111/tmi.12699
Expansion of the Adherence Club model for stable antiretroviral therapy patients in the Cape Metro, South Africa 2011–2015
L. Wilkinson (2016)
90-90-90: An ambitious treatment target to help end the AIDS epidemic
(2014)
10.1111/j.1468-1293.2009.00771.x
Use of a prescription‐based measure of antiretroviral therapy adherence to predict viral rebound in HIV‐infected individuals with viral suppression
V. Cambiano (2010)
10.1136/jfprhc-2012-100379
Prevention of HIV-1 infection with early antiretroviral therapy
M. Rayment (2012)
10.1111/j.1468-1293.2009.00816.x
History of viral suppression on combination antiretroviral therapy as a predictor of virological failure after a treatment change *
J. Reekie (2010)
Provincial Health Department of the Western Cape. HIV antenatal survey
(2012)
10.1097/QAI.0000000000000863
Implementation and Operational Research: Community-Based Adherence Clubs for the Management of Stable Antiretroviral Therapy Patients in Cape Town, South Africa A Cohort Study
A. Grimsrud (2016)
Supporting adherence to antiretroviral therapy: A facility approach to reduce the risk of treatment failure [homepage on the Internet
Médecins Sans Frontières (2012)
10.1002/jia2.25207
Retention in care among clinically stable antiretroviral therapy patients following a six‐monthly clinical consultation schedule: findings from a cohort study in rural Malawi
A. Wringe (2018)
10.1097/QAI.0000000000000553
Retention of Adult Patients on Antiretroviral Therapy in Low- and Middle-Income Countries: Systematic Review and Meta-analysis 2008–2013
M. Fox (2015)
10.7448/IAS.19.1.21484
Reimagining HIV service delivery: the role of differentiated care from prevention to suppression
A. Grimsrud (2016)
10.1093/cid/civ556
Long-term Virological Outcomes of First-Line Antiretroviral Therapy for HIV-1 in Low- and Middle-Income Countries: A Systematic Review and Meta-analysis.
T. S. Boender (2015)
10.7196/SAJHIVMED.980
High rate of virological re-suppression among patients failing second-line antiretroviral therapy following enhanced adherence support: A model of care in Khayelitsha, South Africa
D. Garone (2013)
10.1371/journal.pmed.1002407
Contemporary disengagement from antiretroviral therapy in Khayelitsha, South Africa: A cohort study
Samantha R Kaplan (2017)
10.1001/JAMA.296.6.679
Adherence to antiretroviral therapy in sub-Saharan Africa and North America: a meta-analysis.
E. Mills (2006)
10.1097/QAI.0000000000001137
A Decade of Antiretroviral Therapy Scale-up in Mozambique: Evaluation of Outcome Trends and New Models of Service Delivery Among More Than 300,000 Patients Enrolled During 2004—2013
A. Auld (2016)
10.2174/187152611795589663
HIV treatment adherence, drug resistance, virologic failure: evolving concepts.
J. Nachega (2011)
10.7860/JCDR/2015/12511.6373
HIV Status Disclosure Among People Living with HIV in the Era of Combination Antiretroviral Therapy (cART).
D. Madi (2015)
Improved retention with six month clinic return intervals for stable HIV-infected patients in Zambia
A Mody (2017)
10.1371/journal.pone.0054729
Examining the Link between Patient Satisfaction and Adherence to HIV Care: A Structural Equation Model
B. Dang (2013)
10.1093/inthealth/iht016
Community-based antiretroviral therapy programs can overcome barriers to retention of patients and decongest health services in sub-Saharan Africa: a systematic review.
T. Decroo (2013)
10.1093/infdis/jit411
Viral Suppression Following Switch to Second-line Antiretroviral Therapy: Associations With Nucleoside Reverse Transcriptase Inhibitor Resistance and Subtherapeutic Drug Concentrations Prior to Switch
Victoria H. Johnston (2014)
10.1093/cid/cix756
Improved Retention With 6-Month Clinic Return Intervals for Stable Human Immunodeficiency Virus-Infected Patients in Zambia
Aaloke Mody (2018)
10.1097/01.qai.0000225015.43266.46
Adherence to Highly Active Antiretroviral Therapy Assessed by Pharmacy Claims Predicts Survival in HIV-Infected South African Adults
J. Nachega (2006)
An ambitious treatment target to help end the AIDS epidemic
UNAIDS (2014)
Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: Recommendations for a public health approach
(2016)
10.1089/AID.2011.0284
Primary drug resistance in South Africa: data from 10 years of surveys.
Justen Manasa (2012)
10.1111/tmi.12736
Adherence clubs for long‐term provision of antiretroviral therapy: cost‐effectiveness and access analysis from Khayelitsha, South Africa
Funeka Bango (2016)
10.1086/323201
Antiretroviral therapy adherence and viral suppression in HIV-infected drug users: comparison of self-report and electronic monitoring.
J. Arnsten (2001)
10.1038/nature16046
Sustainable HIV treatment in Africa through viral-load-informed differentiated care
A. Phillips (2015)
10.1111/tmi.12332
Community‐supported models of care for people on HIV treatment in sub‐Saharan Africa
M. Bemelmans (2014)
10.1111/j.1468-1293.2008.00650.x
Factors associated with viral rebound among highly treatment‐experienced HIV‐positive patients who have achieved viral suppression
C. Smith (2009)
10.7448/IAS.20.5.21649
High rates of retention and viral suppression in the scale-up of antiretroviral therapy adherence clubs in Cape Town, South Africa
P. Tsondai (2017)
Supporting adherence to antiretroviral therapy: A facility approach to reduce the risk of treatment failure
Frontières Médecins Sans
10.1111/tmi.12278
Four‐year retention and risk factors for attrition among members of community ART groups in Tete, Mozambique
T. Decroo (2014)
10.1093/ije/dyw057
Cohort Profile: The Khayelitsha antiretroviral programme, Cape Town, South Africa.
K. Stinson (2017)
10.2147/CEOR.S85535
A narrative review of cost-effectiveness analysis of people living with HIV treated with HAART: from interventions to outcomes
Wah Fung Tse (2015)
10.1136/bmjopen-2017-016800
Effect of Community ART Groups on retention-in-care among patients on ART in Tete Province, Mozambique: a cohort study
T. Decroo (2017)
Cape Town: City of Cape Town
(2016)
10.1371/journal.pmed.1001418
Life Expectancies of South African Adults Starting Antiretroviral Treatment: Collaborative Analysis of Cohort Studies
L. Johnson (2013)
10.1097/QAI.0000000000001215
Brief Report: Decentralizing ART Supply for Stable HIV Patients to Community-Based Distribution Centers: Program Outcomes From an Urban Context in Kinshasa, DRC
F. Vogt (2017)
10.1097/01.qai.0000197071.77482.6e
Repeated Measures Longitudinal Analyses of HIV Virologic Response as a Function of Percent Adherence, Dose Timing, Genotypic Sensitivity, and Other Factors
H. Liu (2006)
10.1136/bmjopen-2016-012537
Predictors of treatment failure on second-line antiretroviral therapy among adults in northwest Ethiopia: a multicentre retrospective follow-up study
A. T. Tsegaye (2016)



This paper is referenced by
Semantic Scholar Logo Some data provided by SemanticScholar