VITAL Start: Video-Based Intervention to Inspire Treatment Adherence for Life—Pilot of a Novel Video-Based Approach to HIV Counseling for Pregnant Women Living with HIV

Kim, Maria H.; Ahmed, Saeed; Tembo, Tapiwa; Sabelli, Rachael; Flick, Robert J.; Yu, Xiaoying; Mazenga, Alick; Blond, Holly Le; Simon, Katie; Hartig, Miriam; Wetzel, Elizabeth; Nyirenda, Rose; Kazembe, Peter N.; Mphande, Mtisunge; Mkandawire, Angella; Chitani, Mike J.; Abrams, Elaine J.

doi:10.1007/s10461-019-02634-1

Cited by 15 publications

(30 citation statements)

References 45 publications

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“…Notably, only two papers presented age-disaggregated results [26,27] and one additional paper noted that age did not modify the study results [28]. Among all 37 papers evaluating at least one approach to increase retention, 18 demonstrated no effect on retention [29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46] and 19 reported a significant effect on retention [26][27][28][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62]. Notably, several papers reported significant improvements in retention at some time points but not at others; these are categorized as reporting a significant effect on retention.…”

Section: Resultsmentioning

confidence: 99%

Improving retention in antenatal and postnatal care: a systematic review of evidence to inform strategies for adolescents and young women living with HIV

et al. 2021

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Introduction: Young pregnant and postpartum women living with HIV (WLHIV) are at high risk of poor outcomes in prevention of mother-to-child transmission services. The aim of this systematic review was to collate evidence on strategies to improve retention in antenatal and/or postpartum care in this population. We also conducted a secondary review of strategies to increase attendance at antenatal care (ANC) and/or facility delivery among pregnant adolescents, regardless of HIV status, to identify approaches that could be adapted for adolescents and young WLHIV. Methods: Selected databases were searched on 1 December 2020, for studies published between January 2006 and November 2020, with screening and data abstraction by two independent reviewers. We identified papers that reported agedisaggregated results for adolescents and young WLHIV aged <25 years at the full-text review stage. For the secondary search, we included studies among female adolescents aged 10 to 19 years. Results and discussion: Of 37 papers examining approaches to increase retention among pregnant and postpartum WLHIV, only two reported age-disaggregated results: one showed that integrated care during the postpartum period increased retention in HIV care among women aged 18 to 24 years; and another showed that a lay counsellor-led combination intervention did not reduce attrition among women aged 16 to 24 years; one further study noted that age did not modify the effectiveness of a combination intervention. Mobile health technologies, enhanced support, active follow-up and tracing and integrated services were commonly examined as standalone interventions or as part of combination approaches, with mixed evidence for each strategy. Of 10 papers identified in the secondary search, adolescent-focused services and continuity of care with the same provider appeared to be effective in improving attendance at ANC and/or facility delivery, while home visits and group ANC had mixed results. Conclusions: This review highlights the lack of evidence regarding effective strategies to improve retention in antenatal and/ or postpartum care among adolescents and young WLHIV specifically, as well as a distinct lack of age-disaggregated results in studies examining retention interventions for pregnant WLHIV of all ages. Identifying and prioritizing approaches to improve retention of adolescents and young WLHIV are critical for improving maternal and child health.

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Section: Resultsmentioning

confidence: 99%

Improving retention in antenatal and postnatal care: a systematic review of evidence to inform strategies for adolescents and young women living with HIV

et al. 2021

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“…A major implication of our findings is that the video intervention can help to improve overall service delivery, and this can be achieved in two ways. First, the video saves time; it requires much less time for direct interaction between the client and provider compared to the standard of care [ 26 ]. The saved time allows the provider to focus on service delivery areas that otherwise would not have been attended to or would have been attended to without due diligence.…”

Section: Discussionmentioning

confidence: 99%

“…The study includes pregnant women who are HIV positive by two antibody rapid tests, age ≥18 years or 16–17 years if married or have a child, understand Chichewa (the local language in Malawi), willing to provide informed consent, and intend to remain in the health center catchment area for ≥6 months. Women already on ART, with significant pre-existing psychiatric comorbidity, or who participated in the VITAL Start pilot are excluded [ 26 ]. At all three study sites, HIV testing of pregnant mothers is provided at the antenatal care (ANC) clinic and the pre-ART counseling (VITAL Start or standard of care) is delivered soon after a HIV diagnosis at the same clinic.…”

Section: Introductionmentioning

confidence: 99%

Video-Based Intervention for Improving Maternal Retention and Adherence to HIV Treatment: Patient Perspectives and Experiences

Masiano¹,

Machine²,

Mphande³

et al. 2021

IJERPH

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VITAL Start is a video-based intervention aimed to improve maternal retention in HIV care and adherence to antiretroviral therapy (ART) in Malawi. We explored the experiences of pregnant women living with HIV (PWLHIV) not yet on ART who received VITAL Start before ART initiation to assess the intervention’s acceptability, feasibility, fidelity of delivery, and perceived impact. Between February and September 2019, we conducted semi-structured interviews with a convenience sample of 34 PWLHIV within one month of receiving VITAL Start. The participants reported that VITAL Start was acceptable and feasible and had good fidelity of delivery. They also reported that the video had a positive impact on their lives, encouraging them to disclose their HIV status to their sexual partners who, in turn, supported them to adhere to ART. The participants suggested using a similar intervention to provide health-related education/counseling to people with long term conditions. Our findings suggest that video-based interventions may be an acceptable, feasible approach to optimizing ART retention and adherence amongst PWLHIV, and they can be delivered with high fidelity. Further exploration of the utility of low cost, scalable, video-based interventions to address health counseling gaps in sub-Saharan Africa is warranted.

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“…The theory of planned behavior, to address the cognitive aspects of how patients may conceptualize health threats and appraise barriers to or facilitators of lifelong retention and adherence to ART 3. The information-motivation-behavioral (IMB) skills model, which asserts that knowledge must be linked to both motivation and behavioral skills to overcome barriers critical to achieve adherence [57].…”

Section: Vital Start Intervention Pre-art Counselingmentioning

confidence: 99%

“…In recognizing the critical need for evidence-based, cost-effective, and scalable interventions to improve maternal adherence and retention, our study team developed a brief video-based intervention that provides pregnant women living with HIV a VITAL Start (Video intervention to Inspire Treatment Adherence for Life) at the critical moment before committing to lifelong ART. The pilot demonstrated that the VITAL Start was very feasible to implement, highly accepted by both pregnant women and HCWs, and resulted in excellent knowledge acquisition and better short-term self-reported adherence as compared to the control [57]. In the present trial, we aim to rigorously evaluate the effect of VITAL Start compared to standard of care (SOC) on the primary composite outcome of retention and adherence in a multisite randomized controlled trial.…”

Section: Introductionmentioning

confidence: 99%

The Video intervention to Inspire Treatment Adherence for Life (VITAL Start): protocol for a multisite randomized controlled trial of a brief video-based intervention to improve antiretroviral adherence and retention among HIV-infected pregnant women in Malawi

Kim

Tembo²,

Mazenga³

et al. 2020

Trials

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Background: Improving maternal antiretroviral therapy (ART) retention and adherence is a critical challenge facing prevention of mother-to-child transmission (PMTCT) of HIV programs. There is an urgent need for evidence-based, cost-effective, and scalable interventions to improve maternal adherence and retention that can be feasibly implemented in overburdened health systems. Brief video-based interventions are a promising but underutilized approach to this crisis. We describe a trial protocol to evaluate the effectiveness and implementation of a standardized educational video-based intervention targeting HIV-infected pregnant women that seeks to optimize their ART retention and adherence by providing a VITAL Start (Video intervention to Inspire Treatment Adherence for Life) before committing to lifelong ART. Methods: This study is a multisite parallel group, randomized controlled trial assessing the effectiveness of a brief facility-based video intervention to optimize retention and adherence to ART among pregnant women living with HIV in Malawi. A total of 892 pregnant women living with HIV and not yet on ART will be randomized to standardof-care pre-ART counseling or VITAL Start. The primary outcome is a composite of retention and adherence (viral load < 1000 copies/ml) 12 months after starting ART. Secondary outcomes include assessments of behavioral adherence (self-reported adherence, pharmacy refill, and tenofovir diphosphate concentration), psychosocial impact, and resource utilization. We will also examine the implementation of VITAL Start via surveys and qualitative interviews with patients, partners, and health care workers and conduct cost-effectiveness analyses.

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VITAL Start: Video-Based Intervention to Inspire Treatment Adherence for Life—Pilot of a Novel Video-Based Approach to HIV Counseling for Pregnant Women Living with HIV

Cited by 15 publications

References 45 publications

Improving retention in antenatal and postnatal care: a systematic review of evidence to inform strategies for adolescents and young women living with HIV

Improving retention in antenatal and postnatal care: a systematic review of evidence to inform strategies for adolescents and young women living with HIV

Video-Based Intervention for Improving Maternal Retention and Adherence to HIV Treatment: Patient Perspectives and Experiences

The Video intervention to Inspire Treatment Adherence for Life (VITAL Start): protocol for a multisite randomized controlled trial of a brief video-based intervention to improve antiretroviral adherence and retention among HIV-infected pregnant women in Malawi

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