Effectiveness of a peer educator-coordinated preference-based differentiated service delivery model on viral suppression among young people living with HIV in Lesotho: The PEBRA cluster-randomized trial

Kopo, Mathebe; Lejone, Thabo Ishmael; Bachmann, Nadine; Glass, Tracy R.; Kao, Mpho; Brown, Jennifer Anne; Seiler, Olivia; Muhairwe, Josephine; Moletsane, Ntoli; Labhardt, Niklaus Daniel; Amstutz, Alain

doi:10.1371/journal.pmed.1004150

Cited by 8 publications

(3 citation statements)

References 25 publications

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“…However, CHIEDZA offered additional services for those known to be HIV-positive including community based HIV VL testing, adherence counselling if found to be unsuppressed and adherence and peer support through the CAPS groups. HIV VL testing at CHIEDZA was taken up by two thirds of eligible young people known to be HIV positive and in care elsewhere; more than three-quarters of them were virologically suppressed, comparable to population level estimates for this age group in Southern Africa [ 14 , 38 ]. A minority of young people newly diagnosed or known HIV positive registered with CAPS.…”

Section: Discussionmentioning

confidence: 66%

Differentiated care for youth in Zimbabwe: Outcomes across the HIV care cascade

Dziva Chikwari,

Kranzer,

Simms

et al. 2024

PLOS Glob Public Health

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Youth living with HIV are at higher risk than adults of disengaging from HIV care. Differentiated models of care such as community delivery of antiretroviral therapy (ART) may improve treatment outcomes. We investigated outcomes across the HIV cascade among youth accessing HIV services in a community-based setting. This study was nested in a cluster-randomised controlled trial (CHIEDZA: Clinicaltrials.gov, Registration Number: NCT03719521) conducted in three provinces in Zimbabwe and aimed to investigate the impact of a youth-friendly community-based package of HIV services, integrated with sexual and reproductive health services for youth (16–24 years), on population-level HIV viral load (VL). HIV services included HIV testing, ART initiation and continuous care, VL testing, and adherence support. Overall 377 clients were newly diagnosed with HIV at CHIEDZA, and linkage to HIV care was confirmed for 265 (70.7%, 234 accessed care at CHIEDZA and 31 with other providers); of these 250 (94.3%) started ART. Among those starting ART at CHIEDZA who did not transfer out and had enough follow up time (>6 months), 38% (68/177) were lost-to-follow-up within six months. Viral suppression (HIV Viral Load <1000 copies/ml) among those who had a test at 6 months was 90% (96/107). In addition 1162 clients previously diagnosed with HIV accessed CHIEDZA; 714 (61.4%) had a VL test, of whom 565 (79.1%) were virally suppressed. This study shows that provision of differentiated services for youth in the community is feasible. Linkage to care and retention during the initial months of ART was the main challenge and needs concerted attention to achieve the ambitious 95-95-95 UNAIDS targets.

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Section: Discussionmentioning

confidence: 66%

Differentiated care for youth in Zimbabwe: Outcomes across the HIV care cascade

Dziva Chikwari,

Kranzer,

Simms

et al. 2024

PLOS Glob Public Health

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“… 75 , 76 Also, the consistency of PLLV outcomes irrespective of the Differentiated Service Delivery model lends credibility to reports that Differentiated Service Delivery does not compromise the virological efficacy of dolutegravir-based ART. 77 , 78 …”

Section: Discussionmentioning

confidence: 99%

Prevalence and predictors of persistent low-level HIV viraemia: a retrospective cohort study among people receiving dolutegravir-based antiretroviral therapy in Southern Nigeria

Onwah,

Nwanja,

Akpan

et al. 2024

Therapeutic Advances in Infection

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Background: Persistent low-level viraemia (PLLV) is a risk factor for virologic failure among people receiving antiretroviral therapy (ART). Objectives: We assessed the prevalence and predictors of PLLV among individuals receiving Dolutegravir-based ART in southern Nigeria. Design: This retrospective cohort study used routine program data from electronic medical records of persons receiving Dolutegravir-based first-line ART in 154 PEPFAR/USAID-supported health facilities in Akwa Ibom and Cross Rivers states, Nigeria. Methods: Clients on first-line Dolutegravir-based ART ⩾6 months, who had a viral load result in the 12 months preceding October 2021 (baseline), and a second viral load result by September 2022 were included. Persons with low-level viraemia (LLV) (viral load 51–999 copies/ml) received additional adherence support. The outcome analysed was PLLV (two consecutive LLV results). Indices were summarized using descriptive statistics, and predictors of PLLV were determined using multivariate logistic regression. Results: In total, 141,208 persons on ART were included, of which 63.3% ( n = 89,944) were females. The median age was 36 [29–44] years, median ART duration was 19 [11–42] months. At the end of the study, 10.5% (14,759/141,208) had initial LLV, 90.1% (13,304/14,759) of which attained undetectable viral load (⩽50 copies/ml), and 1.1% (163/14,759) transitioned to virologic failure (⩾1000 copies/ml) by the end of the study. PLLV prevalence was 0.9% (1292/141,208). Increasing ART duration [adjusted odds ratio (aOR) = 1.0; 95% confidence interval (CI): 1.005–1.008; p < 0.001] and viral suppression (<1000 copies/ml) before initial LLV (aOR = 1.7; 95% CI: 1.50–2.00; p < 0.001) were positively associated with PLLV, while receipt of tuberculosis preventive therapy reduced the likelihood of PLLV (aOR = 0.3; 95% CI: 0.10–0.94; p = 0.039). Conclusion: PLLV was uncommon among individuals receiving dolutegravir-based ART and was associated with longer ART duration, prior viral suppression, and non-receipt of tuberculosis preventive therapy. This strengthens recommendations for continuous adherence support and comprehensive health services with ART, to prevent treatment failure.

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“…HIV VL testing at CHIEDZA was taken up by two thirds of eligible young people known to be HIV positive and 77.3% were found to be virologically suppressed which is in line with most of the estimates in this age group. (14, 37) A minority of young people newly diagnosed or known HIV positive registered with CAPS. Possible reasons for limited uptake of CAPS was the distance from young people’s homes to the CHIEDZA centre, the interruptions caused by COVID19 lockdowns and prevailing transport restrictions due to the pandemic.…”

Section: Discussionmentioning

confidence: 99%

Differentiated care for youth across the HIV care cascade in Zimbabwe

Chikwari,

Kranzer,

Simms

et al. 2023

Preprint

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Introduction Youth living with HIV are at higher risk than adults of disengaging from HIV care. Differentiated models of care such as community antiretroviral therapy (ART) may improve treatment outcomes, including viral suppression. Methods This study was nested in a cluster-randomised controlled trial (CHIEDZA: Clinicaltrials.gov, Registration Number:NCT03719521) which was conducted in Harare, Bulawayo and Mashonaland East Provinces in Zimbabwe and aimed to investigate the impact of a youth-friendly community-based package of HIV services, integrated with sexual and reproductive health services for youth (16–24 years), on population-level HIV viral load (VL). HIV services included HIV testing, ART initiation and continuous care, VL testing, and adherence support. Coverage percentages across the HIV care cascade were analysed. Results Overall 377 youth were newly diagnosed with HIV at CHIEDZA, linkage to HIV care was confirmed for 265 (70.7%, 234 accessed care at CHIEDZA and 31 with other providers); 250 (94.3%) started ART. Among those starting ART at CHIEDZA attrition within 6 months of starting ART was 38% and viral suppression (<1000 copies/ml) among those who had a test at 6 months was 90%. In addition 1162 youth already diagnosed with HIV accessed CHIEDZA; 714 (61.4%) had a VL test, of those 565 (79.1%) were virally suppressed. Conclusion This study shows that provision of differentiated services for youth in the community is feasible. Linkage to care and retention during the initial months of ART was the main challenge as has been shown in other studies. Retention throughout the HIV-care journey for youth needs to become a priority programme goal to achieve the ambitious 95-95-95 UNAIDS targets.

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Effectiveness of a peer educator-coordinated preference-based differentiated service delivery model on viral suppression among young people living with HIV in Lesotho: The PEBRA cluster-randomized trial

Cited by 8 publications

References 25 publications

Differentiated care for youth in Zimbabwe: Outcomes across the HIV care cascade

Differentiated care for youth in Zimbabwe: Outcomes across the HIV care cascade

Prevalence and predictors of persistent low-level HIV viraemia: a retrospective cohort study among people receiving dolutegravir-based antiretroviral therapy in Southern Nigeria

Differentiated care for youth across the HIV care cascade in Zimbabwe

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