The transient effect of a peer support intervention to improve adherence among adolescents and young adults failing antiretroviral therapy in Harare, Zimbabwe: a randomized control trial

Chiratidzo E Ndhlovu, Vinie Kouamou, Primrose Nyamayaro, Leanne Dougherty, Nicola Willis, Bisola O Ojikutu, A Tariro Makadzange, Chiratidzo E Ndhlovu, Vinie Kouamou, Primrose Nyamayaro, Leanne Dougherty, Nicola Willis, Bisola O Ojikutu, A Tariro Makadzange

Abstract

Background: Adolescents and young adults living with HIV in sub Saharan Africa are at high risk of poor adherence to antiretroviral therapy (ART) and virologic failure (VF).

Methods: We conducted a randomized control trial among adolescents and young adults on ART with VF to assess the effectiveness of a community-based peer support intervention aimed at improving VF. Viral load (VL) levels were obtained at 12, 24 and 36 weeks. A subset of the participants had baseline HIV drug resistance (HIVDR) genotyped using Sanger sequencing.

Results: The participants' median (interquartile range (IQR)) age was 18.1 (IQR: 15.1-20.0) years and half (50.5%, n = 107) were male. At week 24, the proportion of subjects with a detectable viremia was significantly lower in the intervention arm than in the standard of care (SOC) arm (76.0% (n = 79) vs. 89.0% (n = 96), p = 0.013). At Week 36, there remained a difference in the proportion of subjects with a detectable VL between the intervention arm (68.3%, n = 71) and SOC arm (79.6%, n = 86), which was trending towards statistical significance (p = 0.059). There was no difference in the probability of having a detectable VL over time between the intervention and SOC groups (adjusted odds ratio: 1.14, p = 0.439). Baseline HIVDR was observed in 44.0% of the participants in the intervention and 56.0% in the SOC group (p = 0.146).

Conclusion: A transient effect of the peer support intervention in improving VF was observed among adolescents and young people failing ART.

Trial registration: This study is registered with www.clinicaltrials.gov under the reference number: NCT02833441.

Keywords: Adolescents; HIV; Peer support; Public health; Sub-Saharan Africa; Zimbabwe.

Conflict of interest statement

There are no patents, products in development or marketed products to declare. This does not alter our adherence to all the publication policies on sharing data and materials. The authors declare that they have no competing interests.

Figures

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Fig. 1
Consort diagram

References

    1. UNAIDS . 90-90-90: An ambitious treatment target to help end the AIDS epidemic. Geneva: UNAIDS; 2012. p. 40.
    1. UNAIDS . Global AIDS Update—Seizing the moment—Tackling entrenched inequalities to end epidemics. Geneva: UNAIDS; 2020. p. 384.
    1. World Health Organization. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach. 2016 . Accessed 2 Sep 2020.
    1. Ferrand RA, Simms V, Dauya E, Bandason T, Mchugh G, Mujuru H, et al. The effect of community-based support for caregivers on the risk of virological failure in children and adolescents with HIV in Harare, Zimbabwe (ZENITH): an open-label, randomised controlled trial. Lancet Child Adolesc Health. 2017;1(3):175–183. doi: 10.1016/S2352-4642(17)30051-2.
    1. Dick B, Ferguson BJ. Health for the world’s adolescents: a second chance in the second decade. J Adolesc Health. 2015;56(1):3–6. doi: 10.1016/j.jadohealth.2014.10.260.
    1. Boerma RS, Boender TS, Bussink AP, Calis JCJ, Bertagnolio S, RinkedeWit TF, et al. Suboptimal viral suppression rates among HIV-infected children in low- and middle-income countries: a meta-analysis. Clin Infect Dis. 2016;63(12):1645–54. doi: 10.1093/cid/ciw645.
    1. Enane LA, Vreeman RC, Foster C. Retention and adherence: global challenges for the long-term care of adolescents and young adults living with HIV. Curr Opin HIV AIDS. 2018;13(3):212–219. doi: 10.1097/COH.0000000000000459.
    1. Slogrove AL, Sohn AH. The global epidemiology of adolescents living with HIV: time for more granular data to improve adolescent health outcomes. Curr Opin HIV AIDS. 2018;13(3):170–178. doi: 10.1097/COH.0000000000000449.
    1. Assemie MA, Muchie KF, Ayele TA. Incidence and predictors of loss to follow up among HIV-infected adults at Pawi General Hospital, northwest Ethiopia: competing risk regression model. BMC Res Notes. 2018;11(1):287. doi: 10.1186/s13104-018-3407-5.
    1. Mulongeni P, Hermans S, Caldwell J, Bekker L-G, Wood R, Kaplan R. HIV prevalence and determinants of loss-to-follow-up in adolescents and young adults with tuberculosis in Cape Town. PLOS ONE. 2019;14(2):e0210937. doi: 10.1371/journal.pone.0210937.
    1. Okoronkwo I, Okeke U, Chinweuba A, Iheanacho P. Nonadherence factors and sociodemographic characteristics of HIV-infected adults receiving antiretroviral therapy in Nnamdi Azikiwe University teaching hospital, Nnewi, Nigeria. ISRN AIDS. 2013;2013:1–8. doi: 10.1155/2013/843794.
    1. Lowenthal E, Lawler K, Harari N, Moamogwe L, Masunge J, Masedi M, et al. Rapid psychosocial function screening test identified treatment failure in HIV+ African youth. AIDS Care. 2012;24(6):722–727. doi: 10.1080/09540121.2011.644233.
    1. Mavhu W, Berwick J, Chirawu P, Makamba M, Copas A, Dirawo J, et al. Enhancing Psychosocial Support for HIV Positive Adolescents in Harare, Zimbabwe. Cameron DW, editor. PLoS ONE. 2013 Jul 23;8(7):e70254.
    1. Mutumba M, Musiime V, Lepkwoski JM, Harper GW, Snow RC, Resnicow K, et al. Examining the relationship between psychological distress and adherence to anti-retroviral therapy among Ugandan adolescents living with HIV. AIDS Care. 2016;28(7):807–815. doi: 10.1080/09540121.2015.1131966.
    1. Mavhu W, Willis N, Mufuka J, Mangenah C, Mvududu K, Bernays S, et al. Evaluating a multi-component, community-based program to improve adherence and retention in care among adolescents living with HIV in Zimbabwe: study protocol for a cluster randomized controlled trial. Trials. 2017;18(1):478. doi: 10.1186/s13063-017-2198-7.
    1. Willis N, Milanzi A, Mawodzeke M, Dziwa C, Armstrong A, Yekeye I, et al. Effectiveness of community adolescent treatment supporters (CATS) interventions in improving linkage and retention in care, adherence to ART and psychosocial well-being: a randomised trial among adolescents living with HIV in rural Zimbabwe. BMC Public Health. 2019;19(1):117. doi: 10.1186/s12889-019-6447-4.
    1. Tapera T, Willis N, Madzeke K, Napei T, Mawodzeke M, Chamoko S, et al. Effects of a peer-led intervention on HIV care continuum outcomes among contacts of children, adolescents, and young adults living with HIV in Zimbabwe. Glob Health Sci Pract. 2019;7(4):575–584. doi: 10.9745/GHSP-D-19-00210.
    1. Mavhu W, Willis N, Mufuka J, Bernays S, Tshuma M, Mangenah C, et al. Effect of a differentiated service delivery model on virological failure in adolescents with HIV in Zimbabwe (Zvandiri): a cluster-randomised controlled trial. Lancet Glob Health. 2020;8(2):e264–75. doi: 10.1016/S2214-109X(19)30526-1.
    1. World Health Organization . Adolescent-friendly health services for adolescents living with HIV: From Theory to Practice. Geneva: WHO; 2019.
    1. PEPFAR. Zvandiri: Peer Counseling to Improve Adolescent HIV Care and Support [Internet]. 2018.
    1. Pangaea. Case Study: Identifying Best Practices in HIV Service Delivery. Africaid-Zvandiri Community Adolescent Treatment Supporters. Pangea and Clinton Health Access Initiative, 2017. 2017.
    1. Willis N, Napei T, Armstrong A, Jackson H, Apollo T, Mushavi A, et al. Zvandiri—bringing a differentiated service delivery program to scale for children, adolescents, and young people in Zimbabwe. JAIDS J Acquir Immune Defic Syndr. 2018;78:S115–S123. doi: 10.1097/QAI.0000000000001737.
    1. Makadzange AT, Higgins-Biddle M, Chimukangara B, Birri R, Gordon M, Mahlanza T, et al. Clinical, virologic, immunologic outcomes and emerging HIV drug resistance patterns in children and adolescents in public ART care in Zimbabwe. PLoS ONE. 2015;10(12):e0144057. doi: 10.1371/journal.pone.0144057.
    1. Holodniy M. HIV-1 load quantitation: a 17-year perspective. J Infect Dis. 2006;194:S38–44. doi: 10.1086/505352.
    1. NMTPAC, MOHCC. Guidelines for Antiretroviral Therapy for the Prevention and Treatment of HIV in Zimbabwe [Internet]. 2013.
    1. NMTPAC, MOHCC. Guidelines for Antiretroviral Therapy for the Prevention and Treatment of HIV in Zimbabwe. 2016.
    1. Kouamou V, Varyani B, Shamu T, Mapangisana T, Chimbetete C, Mudzviti T, et al. Drug resistance among adolescents and young adults with virologic failure of first-line antiretroviral therapy and response to second-line treatment. AIDS Res Hum Retroviruses. 2020;36(7):566–573. doi: 10.1089/aid.2019.0232.
    1. Hardin J, Hilbe J. Generalized Estimating Equations. Chapman & Hall/CRC; 2013.
    1. Karahalios A, Baglietto L, Carlin JB, English DR, Simpson JA. A review of the reporting and handling of missing data in cohort studies with repeated assessment of exposure measures. BMC Med Res Methodol. 2012;12(1):96. doi: 10.1186/1471-2288-12-96.
    1. Dziva Chikwari C, Ferrand RA, Simms V. Association between self-reported adherence and HIV viral load suppression among older children and adolescents: JAIDS J Acquir Immune Defic Syndr. 2017;76(3):e87–9. . Accessed 2 July 2019.
    1. Galea JT, Wong M, Muñoz M, Valle E, Leon SR, Díaz Perez D, et al. Barriers and facilitators to antiretroviral therapy adherence among Peruvian adolescents living with HIV: a qualitative study. PLOS ONE. 2018;13(2):e0192791. doi: 10.1371/journal.pone.0192791.
    1. Lowenthal ED, Bakeera-Kitaka S, Marukutira T, Chapman J, Goldrath K, Ferrand RA. Perinatally acquired HIV infection in adolescents from sub-Saharan Africa: a review of emerging challenges. Lancet Infect Dis. 2014;14(7):627–639. doi: 10.1016/S1473-3099(13)70363-3.
    1. Nachega JB, Hislop M, Nguyen H, Dowdy DW, Chaisson RE, Regensberg L, et al. Antiretroviral Therapy Adherence, Virologic and Immunologic Outcomes in Adolescents Compared With Adults in Southern Africa: JAIDS J Acquir Immune Defic Syndr. 2009;51(1):65–71. Available from: . Accessed 2 July 2019.

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