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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Randomized Trial of a "dynamic Choice" Patient-Centered Care Intervention for Mobile Persons with HIV in East Africa
Journal of Acquired Immune Deficiency Syndromes, Volume 95, No. 1, Year 2024
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Description
Background:Persons with HIV (PWH) with high mobility face obstacles to HIV care engagement and viral suppression. We sought to understand whether a patient-centered intervention for mobile PWH would improve viral suppression and retention in care, and if so, which subgroups would benefit most.Methods:In a randomized trial, we evaluated the effect of an intervention designed to address barriers to care among mobile (≥2 weeks out of community in previous year) PWH with viral nonsuppression or recent missed visits in Kenya and Uganda (NCT04810650). The intervention included dynamic choice of a "travel pack" (emergency antiretroviral therapy [ART] supply, discrete ART packaging, and travel checklist), multimonth and offsite refills, facilitated transfer to out-of-community clinics, and hotline access to a mobility coordinator. The primary outcome was viral suppression (<400 copies/mL) at 48 weeks. Secondary outcomes included retention in care and ART possession.Results:From April 2021 to July 2022, 201 participants were enrolled and randomized (102 intervention, 99 control): 109 (54%) were female participants and 101 (50%) from Kenya; median age was 37 years (interquartile range: 29-43). At 48 weeks, there was no significant difference in viral suppression in intervention (85%) vs. control (86%). The intervention improved retention in care (risk ratio: 1.06[1.02-1.1]; P < 0.001) and ART possession (risk ratio: 1.07[1.03-1.11]; P < 0.001), with larger effect sizes among persons with baseline nonsuppression and high mobility (≥2 weeks out of community in previous 3 months).Conclusions:Mobile PWH-centered care should be considered for high-risk mobile populations, including nonsuppressed and highly mobile PWH, to improve retention in care and sustain viral suppression over time.Trial registration:NCT04810650. © 2024 Lippincott Williams and Wilkins. All rights reserved.
Authors & Co-Authors
Ayieko, James
Kenya, Nairobi
Kenya Medical Research Institute
Balzer, Laura B.
United States, Berkeley
University of California, Berkeley
Kakande, Elijah Ronald
Uganda, Kampala
Infectious Diseases Research Collaboration
Opel, Fred J.
Kenya, Nairobi
Kenya Medical Research Institute
Wafula, Erick Mugoma
United States, San Francisco
University of California, San Francisco
Kabami, Jane
Uganda, Kampala
Infectious Diseases Research Collaboration
Owaraganise, Asiphas
Uganda, Kampala
Infectious Diseases Research Collaboration
Mwangwa, Florence
Uganda, Kampala
Infectious Diseases Research Collaboration
Nakato, Hellen
Uganda, Kampala
Infectious Diseases Research Collaboration
Bukusi, Elizabeth Anne
Kenya, Nairobi
Kenya Medical Research Institute
Camlin, Carol S.
United States, San Francisco
University of California, San Francisco
Charlebois, Edwin D.
United States, San Francisco
University of California, San Francisco
Bacon, Melanie C.
United States, Bethesda
National Institute of Allergy and Infectious Diseases Niaid
Petersen, Maya L.
United States, Berkeley
University of California, Berkeley
Kamya, Moses Robert K.
Uganda, Kampala
Makerere University
Havlir, Diane V.
United States, San Francisco
University of California, San Francisco
Chamie, Gabriel
United States, San Francisco
University of California, San Francisco
Statistics
Authors: 17
Affiliations: 6
Identifiers
Doi:
10.1097/QAI.0000000000003311
ISSN:
15254135
Research Areas
Health System And Policy
Infectious Diseases
Study Design
Randomised Control Trial
Study Locations
Multi-countries
Kenya
Uganda
Participants Gender
Female