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

Abstract

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.

The Role of Social Support Among People Living with HIV in Rural Mozambique

“…These findings are consistent with the importance and role of social support for PLHIV in other sub-Saharan Africa countries, including Ethiopia, Lesotho, South Africa, Tanzania, and Uganda. [22][23][24][25][26][27] The majority of social support received by PLHIV in this study was instrumental, followed by emotional and informational/appraisal support. This differs from historical research conducted in the United States in which emotional support was the most common attribute and believed to be the most important.…”

Community-Based Interventions to Improve and Sustain Antiretroviral Therapy Adherence, Retention in HIV Care and Clinical Outcomes in Low- and Middle-Income Countries for Achieving the UNAIDS 90-90-90 Targets

“…Such community-based interventions are likely to have more impact since they tend to involve trained community health workers, peers, volunteers, or patient’s own social network members (e.g., family and friends) who assist with ART adherence counseling and support. In addition, there is evidence that they may provide material, instrumental, and emotional support, as well as promote other healthy behaviors, such as decreased alcohol and drug use, leading to better health outcomes—including survival [14, 24, 29, 32]. Furthermore, enhancing certain aspects of the patient–supporter relationships—such as trust, supporter availability, communication, reciprocity of support, and medication assistance—in a manner consistent with patients’ expectations may help to optimize the relationship and its positive impact on patient health [14, 24, 70].…”

The Role of Maternal, Health System, and Psychosocial Factors in Prevention of Mother-to-Child Transmission Failure in the Era of Programmatic Scale Up in Western Kenya: A Case Control Study

“…36 Health system capacity can be strengthened by ensuring autonomy over resources at lower levels; linking performance management interventions to facility-wide human resources management; and developing accountability systems to ensure that health workers and managers are responsible for their performance. 39,40 In addition, health systems should aim not only to provide knowledge to women but also to cultivate a supportive relationship that enables the women to apply the new knowledge to their daily lives, and come up with solutions to challenges to healthy daily routines. 36,41 This can only happen if patient-provider communication is improved at every stage of the continuum of care.…”

“…35 Strategies may also include patient-selected community-based treatment supporters to improve understanding of HIV and PMTCT particularly for newly diagnosed women. 21,39 Home visits by trained nurses or community health workers can be introduced to circumvent challenges such as expensive transport, long waiting lines, and discordant mother-infant clinic appointments, 36 and by extension enhance maternal and child outcomes. 39,41 Our finding that stigma and other psychosocial factors did not increase the odds of MTCT differs from prior studies in the region that have found that fears of HIV-related stigma and discrimination negatively impact service uptake and adherence at each step of the PMTCT cascade.…”