How Treatment Partners Help: Social Analysis of an African Adherence Support Intervention

O’Laughlin, Kelli N.; Wyatt, Monique A.; Kaaya, Sylvia; Bangsberg, David R.; Ware, Norma C.

doi:10.1007/s10461-011-0038-4

Cited by 59 publications

(55 citation statements)

References 39 publications

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“…Further, interventions capitalizing on social support to promote adherence in non-refugee settings have begun to take hold and should be considered in refugee settings. Treatment partners have been shown to combat stigma, increase hope, and reduce social exclusion (O'Laughlin, Wyatt, Kaaya, Bangsberg, & Ware, 2012). Peer-led treatment groups have been suggested to increase adherence and promote social support (Decroo et al, 2011).…”

Section: Discussionmentioning

confidence: 99%

The role of social support on HIV testing and treatment adherence: A qualitative study of HIV-infected refugees in southwestern Uganda

Rouhani

O’Laughlin

Faustin

et al. 2016

Global Public Health

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Little is known about the factors that encourage or discourage refugees to test for HIV, or to access and adhere to HIV care. In non-refugee populations, social support has been shown to influence HIV testing and utilization of services. The present study enrolled HIV-infected refugees on anti-retroviral therapy (ART) in Uganda, who participated in qualitative interviews on HIV testing, treatment, and adherence. Interviews were analyzed for themes about four types of social support: emotional, informational, instrumental and appraisal support. A total of 61 interviews were analyzed. Four roles for these types of social support were identified: (1) informational support encouraged refugees to test for HIV; (2) emotional support helped refugees cope with a diagnosis of HIV; (3) instrumental support facilitated adherence to ART and (4) after diagnosis, HIV-infected refugees provided informational and emotional support to encourage other refugees to test for HIV. These results suggest that social support influences HIV testing and treatment among refugees. Future interventions should capitalize on social support within a refugee settlement to facilitate testing and treatment.

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Section: Discussionmentioning

confidence: 99%

The role of social support on HIV testing and treatment adherence: A qualitative study of HIV-infected refugees in southwestern Uganda

Rouhani

O’Laughlin

Faustin

et al. 2016

Global Public Health

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“…Whereas treatment supporters promote status disclosure and reduce stigma through a single supportive relationship, 23 microclinics provide this degree of support by means of patient’s broader social network. In addition, microclinics also promote the role of ‘expert patients’ commonly found in patient support group interventions.…”

Section: Discussionmentioning

confidence: 99%

“…21,22 Evidence suggests that these interventions may reduce stigma and facilitate disclosure. 23 However, by focusing exclusively on a single treatment supporter or a group of patient peers, these interventions may not fully utilize the pre-existing social infrastructure that patients engage with throughout daily life.…”

Section: Introductionmentioning

confidence: 99%

Implementation and Operational Research

Hickey

Salmen

Omollo³

et al. 2015

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background Despite progress in the global scale-up of antiretroviral therapy, sustained engagement in HIV care remains challenging. Social capital is an important factor for sustained engagement, but interventions designed to harness this powerful social force are uncommon. Methods We conducted a quasi-experimental study evaluating the impact of the Microclinic social network intervention on engagement in HIV care and medication adherence on Mfangano Island, Kenya. The intervention was introduced into 1 of 4 similar communities served by this clinic; comparisons were made between communities using an intention-to-treat analysis. Microclinics, composed of patient-defined support networks, participated in ten bi-weekly discussion sessions covering topics ranging from HIV biology to group support, as well as group HIV status disclosure. Nevirapine concentrations in hair were measured pre-and-post study. Results 113 (74%) intervention community participants joined a microclinic group, 86% of whom participated in group HIV status disclosure. Over 22-months of follow-up, intervention community participants experienced one-half the rate of ≥ 90-day clinic absence as those in control communities (adjusted hazard ratio 0.48, 95%CI 0.25–0.92). Nevirapine hair levels declined in both study arms; in adjusted linear regression analysis, the decline was 6.7 ng/mg less severe in the intervention arm than control arm (95% CI −2.7 to 16.1). Conclusions The microclinic intervention is a promising and feasible community-based strategy to improve long-term engagement in HIV care and possibly medication adherence. Reducing treatment interruptions using a social network approach has important implications for individual patient virologic suppression, morbidity and mortality, and for broader community empowerment and engagement in healthcare.

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“…Such an inductive approach is an established method for analyzing qualitative research, and has been used in research analyzing patient experiences of treatment supporters in Tanzania. 16,17 Permission for the parent study was obtained from the IRBs of Johns Hopkins University and the University of Cape Town.…”

Section: Discussionmentioning

confidence: 99%

“…These benefits are consistent with those noted in the recent study by O'Laughlin and colleagues that highlighted the role of treatment supporters in promoting the social health of HIV-infected persons in Tanzania. 23 Further, participation in a formal training program may enhance the benefits of a patient-supporter relationship. In this study, DOT-ART patients were significantly more likely to feel that their supporter affected their alcohol and drug use behavior.…”

Section: Discussionmentioning

confidence: 99%

Patient-Nominated, Community-Based HIV Treatment Supporters: Patient Perspectives, Feasibility, Challenges, and Factors for Success in HIV-Infected South African Adults

Duwell

Knowlton

Nachega

et al. 2013

AIDS Patient Care and STDs

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This study aimed to characterize the experience of having a treatment supporter among HIV-infected South African patients enrolled in a randomized controlled trial that compared the efficacy of patient-nominated treatment supporters administering partial directly observed antiretroviral therapy (DOT-ART) versus selfadministered ART (Self-ART). Results of the parent study showed no virologic or sustained immunologic differences between groups, but revealed a significant survival benefit among the DOT-ART group. One hypothesis is that this survival benefit may be explained by differences in the training and involvement of the treatment supporters between groups. In the current study, results from a semi-structured exit interview of 172 participants indicate that most participants in both arms maintained a positive, satisfying relationship with a single supporter, typically family member or friend. Most patients (82.6%) perceived supporters as helpful with medication adherence, with no significant difference between groups ( p = 0.752). Additionally, supporters provided emotional, instrumental, and material support. DOT-ART patients were more likely than Self-ART patients to report that their supporter helped to decrease drug or alcohol use (p = 0.03). Patients identified supporter trustworthiness, availability, good communication and reciprocity of support as factors beneficial to a successful relationship. These results suggest: (1) Patient-nominated peers are feasible candidates for ART supporters in this resource-constrained setting; (2) In addition to assistance with medications, treatment supporters have the capacity to promote healthy behaviors and provide other types of support, which may contribute to improved outcomes, particularly with enhanced training; (3) Trustworthiness, availability, good communication, and reciprocity are key factors in a successful patient-supporter relationship.

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How Treatment Partners Help: Social Analysis of an African Adherence Support Intervention

Cited by 59 publications

References 39 publications

The role of social support on HIV testing and treatment adherence: A qualitative study of HIV-infected refugees in southwestern Uganda

The role of social support on HIV testing and treatment adherence: A qualitative study of HIV-infected refugees in southwestern Uganda

Implementation and Operational Research

Patient-Nominated, Community-Based HIV Treatment Supporters: Patient Perspectives, Feasibility, Challenges, and Factors for Success in HIV-Infected South African Adults

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