Patients’ and Providers’ Views on Optimal Evidence-Based and Scalable Interventions for Individuals at High Risk of HIV Treatment Failure: Sequential Explorations Among Key Stakeholders in Cape Town, South Africa

Sabin, Lora; Gifford, Allen L.; Haberer, Jessica; Harvey, Kelsee; Sarkisova, Natalya; Martin, Kyle; West, Robin; Stephens, Jessie; Killian, Clare; Halim, Nafisa; Berkowitz, Natacha; Jennings, Karen; Jennings, Lauren; Orrell, Catherine

doi:10.1007/s10461-022-03623-7

Cited by 4 publications

(4 citation statements)

References 61 publications

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“…This protocol gives the client the ability to collaborate with health providers, institutions, and others to improve their own care. Improved adherence, increased motivation and confidence, and mutual support, as observed by Sabin (30), result in higher levels of physical, psychological, and social well-being and improved health outcomes (30).…”

Section: Discussionmentioning

confidence: 97%

Barriers and enablers to accessing HIV services at South Sudan military facilities: Using qualitative data for program improvement

Lasu,

Changjowk,

Fezeu Meyou

et al. 2023

Preprint

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IntroductionSouth Sudan established an HIV program for the South Sudan People’s Defense Force (SSPDF) in 2006, recognizing the potential national security threat posed by HIV’s impact in post-conflict settings. By 2018, the SSPDF program’s scope had expanded to include three VMMC clinics and four ART service delivery facilities. This qualitative study examined participant feedback on two existing HIV services, ART and VMMC, with the goal of identifying and prioritizing barriers and improving program performance. We used focus group discussions to gather information from male and female participants chosen at random across the four main project sites.MethodsWe conducted a cross-sectional qualitative study from March to April 2022 involving 177 people (108 men and 69 women) within fifteen focus group discussions. We collected data on enablers and barriers to HIV service uptake and utilization using a thematic framework approach.ResultsPerceived high-quality HIV services in a secure environment, organizational support systems, peer-led mobilization, and transportation facilitation were all identified as HIV service delivery enablers. HIV service delivery was hampered by knowledge gaps, poverty and food insecurity, access issues, a lack of treatment support groups, transportation challenges, social cultural barriers (stigma and discrimination), and the need for permission from commanders.ConclusionsThe findings show some overlap in client needs for VMMC and ART services. To increase ART retention and overall HIV service demand, the program will focus on improving the quality of HIV services and tailored client support, as well as addressing barriers resulting from structural and social cultural challenges to increase ART retention and overall HIV service demand.

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Section: Discussionmentioning

confidence: 97%

Barriers and enablers to accessing HIV services at South Sudan military facilities: Using qualitative data for program improvement

Lasu,

Changjowk,

Fezeu Meyou

et al. 2023

Preprint

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“…Interestingly, cost and feasibility seemed to have the greatest influence on intervention preferences, although effectiveness and acceptability received the highest ratings in the think-aloud priority-setting tasks in this study. Like in a previous qualitative study [ 47 ], high-level stakeholders favored simple interventions with minimal costs that removed structural barriers to care (e.g., extended hours, MMD) over those that were perceived as highly effective but needed additional systems and human resources (e.g., peer support and community-based care).…”

Section: Discussionmentioning

confidence: 98%

Stakeholder Priorities for ART Initiation and Early Retention Interventions in Malawi: A Qualitative Study Comparing International and National Perspectives

Hariprasad,

Phiri,

Thorp

et al. 2023

Preprint

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Background New or returning ART clients are often ineligible for differentiated service delivery (DSD) models, though they are at increased risk of treatment interruption and may benefit greatly from flexible care models. Stakeholder support may limit progress on development and scale-up of interventions for this population. We qualitatively explored stakeholder perceptions of and decision-making criteria regarding DSD models for new or returning ART clients in Malawi. Methods We conducted in-depth interviews with internationally based stakeholders (from foundations, multilateral organizations, and NGOs) and Malawi-based stakeholders (from the Malawi Ministry of Health and PEPFAR implementing partners). The interviews included two think-aloud scenarios in which participants rated and described their perceptions of 1) the relative importance of five criteria (cost, effectiveness, acceptability, feasibility, and equity) in determining which interventions to implement for new or returning ART clients and 2) their relative interest in seven potential interventions (monetary incentives, nonmonetary incentives, community-based care, ongoing peer/mentor support and counseling, eHealth, facility-based interventions, and multimonth dispensing) for the same population. The interviews were completed in English via video conference and were audio-recorded. Transcriptions were coded using ATLAS.ti version 9. We examined the data using thematic content analysis and explored differences between international and national stakeholders. Results We interviewed twenty-two stakeholders between October 2021 and March 2022. Thirteen were based internationally, and nine were based in Malawi. Both groups prioritized client acceptability but diverged on other criteria: international stakeholders prioritized effectiveness, and Malawi-based stakeholders prioritized cost, feasibility, and sustainability. Both stakeholder groups were most interested in facility-based DSD models, such as multimonth dispensing and extended facility hours. Nearly all the stakeholders described person-centered care as a critical focus for any DSD model implemented. Conclusions National and international stakeholders support DSD models for new or returning ART clients. Client acceptability and long-term sustainability should be prioritized to address the concerns of nationally based stakeholders. Future studies should explore the reasons for differences in national and international stakeholders’ priorities and how to ensure that local perspectives are incorporated into funding and programmatic decisions.

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“…In sum, this study aims to use innovative methods to make progress on moving effective ART adherence interventions into clinics where they will be of help to patients. We began by identifying effective and scalable interventions from the literature and then, through further research, selected those that were acceptable to a wide range of stakeholders (health department officials, healthcare providers, and patients) [ 50 ]. Through the SUSTAIN study, we will simultaneously assess these interventions in order to provide policy makers with the best possible evidence (using both HIV-related outcomes and implementation-related outcomes) to decide which combination intervention package will most improve outcomes in patients starting ART in primary care clinics.…”

Section: Discussionmentioning

confidence: 99%

“…We partnered with local officials and clinical staff in Cape Town to review evidence for adherence interventions and conduct formative research to identify the most effective, acceptable, and feasible intervention components for patients and providers. These components formed the basis for a pilot study [ 50 ] in which we used in-depth interviews (IDIs) with patients and focus groups with providers to determine the most preferred intervention components to advance to the next phase. For our final study design for the optimization phase, we incorporated the two most preferred support strategies identified in our pilot study: (a) weekly check-in texts (S1); and (b) enhanced peer support, using motivational interviewing (MI) (S2).…”

Section: Methodsmentioning

confidence: 99%

Protocol for an evaluation of adherence monitoring and support interventions among people initiating antiretroviral therapy in Cape Town, South Africa—a multiphase optimization strategy (MOST) approach using a fractional factorial design

Jennings

West

Halim

et al. 2023

Trials

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Background South Africa bears a large HIV burden with 7.8 million people with HIV (PWH). However, due to suboptimal antiretroviral therapy (ART) adherence and retention in care, only 66% of PWH in South Africa are virally suppressed. Standard care only allows for suboptimal adherence detection when routine testing indicates unsuppressed virus. Several adherence interventions are known to improve HIV outcomes, yet few are implemented in routinely due to the resources required. Therefore, determining scalable evidence-based adherence support interventions for resource-limited settings (RLS) is a priority. The multiphase optimization strategy (MOST) framework allows for simultaneous evaluation of multiple intervention components and their interactions. We propose to use MOST to identify the intervention combination with the highest levels of efficacy and cost-effectiveness that is feasible and acceptable in primary care clinics in Cape Town. Methods We will employ a fractional factorial design to identify the most promising intervention components for inclusion in a multi-component intervention package to be tested in a future randomized controlled trial. We will recruit 512 participants initiating ART between March 2022 and February 2024 in three Cape Town clinics and evaluate acceptability, feasibility, and cost-effectiveness of intervention combinations. Participants will be randomized to one of 16 conditions with different combinations of three adherence monitoring components: rapid outreach following (1) unsuppressed virus, (2) missed pharmacy refill collection, and/or (3) missed doses as detected by an electronic adherence monitoring device; and two adherence support components: (1) weekly check-in texts and (2) enhanced peer support. We will assess viral suppression (<50 copies/mL) at 24 months as the primary outcome; acceptability, feasibility, fidelity, and other implementation outcomes; and cost-effectiveness. We will use logistic regression models to estimate intervention effects with an intention-to-treat approach, employ descriptive statistics to assess implementation outcomes, and determine an optimal intervention package. Discussion To our knowledge, ours will be the first study to use the MOST framework to determine the most effective combination of HIV adherence monitoring and support intervention components for implementation in clinics in a RLS. Our findings will provide direction for pragmatic, ongoing adherence support that will be key to ending the HIV epidemic. Trial registration ClinicalTrials.gov NCT05040841. Registered on 10 September 2021.

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Patients’ and Providers’ Views on Optimal Evidence-Based and Scalable Interventions for Individuals at High Risk of HIV Treatment Failure: Sequential Explorations Among Key Stakeholders in Cape Town, South Africa

Cited by 4 publications

References 61 publications

Barriers and enablers to accessing HIV services at South Sudan military facilities: Using qualitative data for program improvement

Barriers and enablers to accessing HIV services at South Sudan military facilities: Using qualitative data for program improvement

Stakeholder Priorities for ART Initiation and Early Retention Interventions in Malawi: A Qualitative Study Comparing International and National Perspectives

Protocol for an evaluation of adherence monitoring and support interventions among people initiating antiretroviral therapy in Cape Town, South Africa—a multiphase optimization strategy (MOST) approach using a fractional factorial design

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