Improving Clinic Attendance and Adherence to Antiretroviral Therapy Through a Treatment Supporter Intervention in Uganda: A Randomized Controlled Trial

Abstract

We assessed the effectiveness of the treatment supporter initiative as an intervention in improving clinic attendance for antiretroviral (ARV) drug refills and adherence to antiretroviral therapy (ART) in a cohort of HIV-infected adults. This two-arm randomized controlled trial was undertaken at an HIV clinic in a district hospital in Uganda. A total of 174 adult patients on ART were randomized 1:1 to a standard adherence intervention package plus a treatment supporter intervention (TS arm) or to a standard adherence intervention package (non-TS arm) alone. Clinic attendance for refills and adherence measurements using monthly clinic-based pill counts were monitored for both arms for 28 weeks. Baseline characteristics were similar for both arms. There was a non-significant difference in mean adherence between the TS and non-TS groups at end of follow-up [99.1% (95% CI: 98.3-99.9% vs. 96.3% (95% CI: 94.2-98.3%), P > 0.05]. TS participants had more than four times the odds of achieving optimal adherence (≥95%) [Odds ratio (OR) = 4.51, 95% CI: 1.22-16.62, exact P = 0.027]. TS participants were also more likely to be on time for their clinic appointments: 91.6 vs. 90.1% for TS and non-TS, respectively (OR = 1.19, 95% CI: 0.74-1.91, P > 0.05). Use of patient-selected treatment supporters may be an effective intervention to improve ARV treatment outcomes in resource-constrained settings.

Personal barriers to antiretroviral therapy adherence: Case studies from a rural Uganda prospective clinical cohort

“…Pt4 was an orphan who had lost his mother yet ART adherence problems among adolescents are aggravated by orphan-hood and lack of social support 15,19 . In Uganda, patient-selected treatment supporters improved ART treatment outcomes, especially at the start of ART [42][43] . Pt2 had no treatment supporter which hindered her ART adherence while the treatment supporter of Pt4 did not leave the ART medications to him or with another adult to supervise the intake.…”

Interventions for Enhancing Adherence to Antiretroviral Therapy (ART): A Systematic Review of High Quality Studies

“…A summary of all the included HIV studies is reported in 74 Mozambique, 75 Switzerland, 76 Uganda, 77 South Africa, 78 and Nigeria. 79 The country in which the study was conducted was not reported in five studies.…”

“…39,47,78,79,82 Interventions. Based on the factors responsible for poor adherence, the interventions were categorized as patient related (n = 31), 36 37,62,63,69,83 social and economic factors (n = 1), 77 and condition related (n = 1). 44 The interventions in thirty-nine of these studies targeted only the patient; …”

“…62 One of 11 (9.1%) complex interventions improved adherence and clinical outcomes. 73 None of the interventions for condition-related 44 and socioeconomic difficulties 77 was successful for both adherence and clinical outcomes.…”

The Effect of Stigma on Treatment Adherence among HIV-positive Alcohol Users in Haiti

“…Tangible/instrumental social support can range from making a meal for someone to driving that person to the doctor's office. In some situations, individuals need material goods or tangible actions to help them overcome challenging circumstances (Sherbourne & Stewart, 1991 (Kunutsor, 2011). Similarly, many studies have documented a direct relationship between tangible/instrumental social support and increased adherence to ART (Gonzalez et al, 2004, Ulett et al, 2009.…”