A combination strategy for enhancing linkage to and retention in HIV care among adults newly diagnosed with HIV in Mozambique: study protocol for a site-randomized implementation science study

Elul, Batya; Lahuerta, María; Abacassamo, Fátima; Lamb, Matthew R.; Ahoua, Laurence; McNairy, Margaret L.; Tomo, Maria; Horowitz, Deborah R.; Sutton, Roberta; Mussa, Antonio; Gurr, Danielle; Jani, Ilesh

doi:10.1186/s12879-014-0549-5

Cited by 29 publications

(29 citation statements)

References 23 publications

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“…Finally, this study only focuses on linkage to care and does not include a focus on retention in care. The HIV treatment cascade (Rosen & Fox, 2011;Valdiserri, 2012) demonstrates that more attention is needed at all stages of the continuum of care, especially in sub-Saharan Africa (Elul et al, 2014).…”

Section: Discussionmentioning

confidence: 99%

Using a call center to encourage linkage to care following mobile HIV counseling and testing

2015

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Engaging newly diagnosed HIV+ individuals in treatment is a significant global challenge. As South Africa expands HIV counseling and testing (HCT) services, the growing numbers of people diagnosed with HIV will need innovative links to care approaches in order for treatment to be most effective. While definitions vary, we have defined "linkage to care" as connecting an HIV+ individual to medical care, so that CD4 cell test results are obtained and antiretroviral therapy (ART) eligibility assessed. The study is of HIV+ participants (n = 1096), from either Limpopo or Gauteng provinces from a "Links to Care" program. A two-pronged expanded HCT service was used, which included a community outreach approach to address HIV testing and a call center to encourage and track each patient's linkage to care post-HIV diagnosis. The majority of individuals (51%) were linked to care with a mean time to linkage of 31 days (with most individuals linked in less than 14 days). More females (54%) were linked to care than males (47%) and had higher CD4 cell counts than males; females had a mean CD4 cell count of 440, while males took longer to link to care and had a lower mean CD4 cell count of 331. Females of 23 years or younger had the lowest linkage rate of all females. Findings suggest that expanding HCT services to include innovative links to care approaches can improve linkage to care and subsequently impact HIV prevention.

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Section: Discussionmentioning

confidence: 99%

Using a call center to encourage linkage to care following mobile HIV counseling and testing

2015

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“…16 In brief, the study used a 2-arm cluster site-randomized design to determine the effectiveness of a combination intervention strategy compared with the standard of care in improving linkage and retention among adults after HIV diagnosis. The study was conducted at 10 health facilities in urban Maputo City and rural Inhambane Province.…”

Section: Methodsmentioning

confidence: 99%

“…16 Beyond providing data on the effectiveness of the combination intervention strategy (which will be presented separately), the study offers an unique opportunity to document and assess “real-world” implementation successes and challenges for a set of interventions targeting linkage to and retention in HIV care. Given the growing interest in identifying feasible and acceptable health communication interventions, this paper presents results from a process evaluation which compares the feasibility and acceptability of health communication versus structural interventions as part of the combination intervention strategy.…”

Section: Introductionmentioning

confidence: 99%

Feasibility and Acceptability of Health Communication Interventions Within a Combination Intervention Strategy for Improving Linkage and Retention in HIV Care in Mozambique

Sutton

Lahuerta

Abacassamo³

et al. 2017

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background:Challenges to ensuring timely linkage to and retention in HIV care are well documented. Combination intervention strategies can be effective in improving the HIV care continuum. Data on feasibility and acceptability of intervention types within intervention packages are limited.Methods:The Engage4Health study assessed the effectiveness of a combination intervention strategy to increase linkage and retention among adults newly diagnosed with HIV in Mozambique. The study included 2 health communication interventions—modified delivery of pre-antiretroviral therapy (pre-ART) counseling sessions and SMS reminders—and 3 structural interventions—point-of-care CD4 testing after diagnosis, accelerated ART initiation, and noncash financial incentives. We used a process evaluation framework to assess dose delivered—extent each intervention was delivered as planned—and dose received—participant acceptability—of health communication versus structural interventions in the effectiveness study to understand associated benefits and challenges. Data sources included study records, participant interviews, and clinical data.Results:For dose delivered of health communication interventions, 98% of eligible clients received pre-ART counseling and 90% of participants received at least one SMS reminder. For structural interventions, 74% of clients received CD4 testing and 53% of eligible participants initiated ART within 1 month. Challenges for structural interventions included facility-level barriers, staffing limitations, and machine malfunctions. For dose received, participants reported pre-ART counseling and CD4 testing as the most useful interventions for linkage and financial incentives as the least useful for linkage and retention.Discussion:Findings demonstrate that health communication interventions can be feasibly and acceptably integrated with structural interventions to create combination intervention strategies.

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“…Ethical clearance for the study was provided by Columbia University and Mozambique’s National Committee for Bioethics in Health. Further study details are available elsewhere (Elul et al, 2014). …”

Section: Methodsmentioning

confidence: 99%

Informing efforts to reach UNAIDS’ 90–90–90 targets: a comparison of characteristics of people diagnosed with HIV in health facilities to the general population of people living with HIV in Mozambique

et al. 2017

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Global targets aim to increase the number of people living with HIV (PLWH) who know their status. Using data from Mozambican facility-based HIV testing and counseling (HTC) and a population-based survey, we compared characteristics of PLWH diagnosed in HTC to the general population of PLWH to identify subgroups that are missing from the health system and may be undiagnosed. Male and female PLWH aged 50+ (PPR=0.47, p=0.0001) and with higher HIV knowledge (PPR=0.52, p=0.004) were underrepresented in HTC. A higher proportion of patients diagnosed in health facilities were aged 25–39 (PPR=1.23, p=0.02). Female PLWH with lower economic (PPR=0.70, p=0.04) and educational status (PPR=0.86, p=0.02), and male PLWH aged 18–24 (PPR=0.47, p=0.03) were underrepresented in HTC. Comparing HTC data to population-based data can inform efforts to increase HIV diagnoses and to ensure that all PLWH know their status.

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A combination strategy for enhancing linkage to and retention in HIV care among adults newly diagnosed with HIV in Mozambique: study protocol for a site-randomized implementation science study

Cited by 29 publications

References 23 publications

Using a call center to encourage linkage to care following mobile HIV counseling and testing

Using a call center to encourage linkage to care following mobile HIV counseling and testing

Feasibility and Acceptability of Health Communication Interventions Within a Combination Intervention Strategy for Improving Linkage and Retention in HIV Care in Mozambique

Informing efforts to reach UNAIDS’ 90–90–90 targets: a comparison of characteristics of people diagnosed with HIV in health facilities to the general population of people living with HIV in Mozambique

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