Page 134 - SAHCS HIVMed Journal Vol 20 No 1 2019

Southern African Journal of HIV Medicine
ISSN: (Online) 2078-6751, (Print) 1608-9693
Page 1 of 7 Original Research

Outcomes of patients enrolled in an antiretroviral

adherence club with recent viral suppression after

experiencing elevated viral loads

Authors: Background: Eligibility for differentiated antiretroviral therapy (ART) delivery models has to
Joseph Sharp 1 date been limited to low-risk stable patients.
Lynne Wilkinson 2,3,4
Vivian Cox 3 Objectives: We examined the outcomes of patients who accessed their care and treatment
Carol Cragg 5
Gilles van Cutsem through an ART adherence club (AC), a differentiated ART delivery model, immediately
2,3
Anna Grimsrud 4 following receiving support to achieve viral suppression after experiencing elevated viral
loads (VLs) at a high-burden ART clinic in Khayelitsha, South Africa.
Affiliations:
1 Emory University School Methods: Beginning in February 2012, patients with VLs above 400 copies/mL either on first-
of Medicine, Atlanta, or second-line regimens received a structured intervention developed for patients at risk of
United States
treatment failure. Patients who successfully suppressed either on the same regimen or after
2 Médecins Sans Frontières, regimen switch were offered immediate enrolment in an AC facilitated by a lay community
Cape Town, South Africa health worker. We conducted a retrospective cohort analysis of patients who enrolled in an
AC directly after receiving suppression support. We analysed outcomes (retention in care,
3 Centre for Infectious Disease retention in AC care and viral rebound) using Kaplan–Meier methods with follow-up from
Epidemiology and Research,
School of Public Health and October 2012 to June 2015.
Family Medicine, University Results: A total of 165 patients were enrolled in an AC following suppression (81.8% female,
of Cape Town, Cape Town,
South Africa median age 36.2 years). At the closure of the study, 119 patients (72.0%) were virally suppressed
and 148 patients (89.0%) were retained in care. Six, 12 and 18 months after AC enrolment,
4 International AIDS Society, retention in care was estimated at 98.0%, 95.0% and 89.0%, respectively. Viral suppression
Cape Town, South Africa was estimated to be maintained by 90.0%, 84.0% and 75.0% of patients at 6, 12 and 18 months
after AC enrolment, respectively.
5 Provincial Department
of Health, Western Cape, Conclusion: Our findings suggest that patients who struggled to achieve or maintain viral
Cape Town, South Africa
suppression in routine clinic care can have good retention and viral suppression outcomes in
Corresponding author: ACs, a differentiated ART delivery model, following suppression support.
Joseph Sharp,
[email protected] Keywords: Differentiated care; Retention; Viral suppression; Adherence; High-risk patients;
ART delivery.
Dates:
Received: 30 Aug. 2018
Accepted: 17 Apr. 2019
Published: 11 June 2019 Introduction
The introduction of antiretroviral therapy (ART) for the treatment of HIV has led to massive
How to cite this article:
1,2
Sharp J, Wilkinson L, Cox V, reductions in mortality and slowed the progression of disease and transmission of infection.
et al. Outcomes of patients These reductions are contingent upon strict adherence to ART regimens and long-term retention
enrolled in an antiretroviral in care. Treatment programmes throughout the world are both expanding to meet the Joint
3,4
adherence club with recent
viral suppression after United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 targets and continuing to mature,
experiencing elevated as the first patients initiated in some treatment programmes will soon enter their third decade on
viral loads. S Afr J HIV Med. ART. Despite advances in the reduction of the costs of treatment, the stigma associated with
6
5
2019;20(1), a905. https://doi. infection and the need to integrate treatment into daily routines, increasing numbers of patients
8,9
7
org/10.4102/sajhivmed.
v20i1.905 are interrupting care and experiencing viral rebound. While retention has been consistent between
74% and 78% at 12 months from 2005 to 2013, the number of patients in care globally has
10
increased dramatically from 1.3 million in 2005 to over 21.7 million in 2017. This trend is evident
11
12
in South Africa where the treatment programme has grown from just less than 100 000 to over 4
million patients, and concurrently, the number of patients interrupting or abandoning care has
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Copyright: © 2019. The Authors. Licensee: AOSIS. This work is licensed under the Creative Commons Attribution License.
http://www.sajhivmed.org.za 127 Open Access