Differentiated HIV care in South Africa: the effect of fast-track treatment initiation counselling on ART initiation and viral suppression as partial results of an impact evaluation on the impact of a package of services to improve HIV treatment adherence

By  Sophie Pascoe  Matthew Fox  Amy Huber  Joshua Murphy  Mokgadi Phokojoe, Marelize Gorgens  Sydney Rosen  David Wilson, Yogan Pillay and Nicole Fraser-Hurt  |  | 

Introduction: In response to suboptimal adherence and retention, South Africa’s National Department of Health developed and implemented National Adherence Guidelines for Chronic Diseases. We evaluated the effect of a package of adherence interventions beginning in January 2016 and report on the impact of Fast-Track Treatment Initiation Counselling (FTIC) on ART initiation, adherence and retention.
Methods: We conducted a cluster-randomized mixed-methods evaluation in 4 provinces at 12 intervention sites which implemented FTIC and 12 control facilities providing a standard of care. Follow-up was by passive surveillance using clinical records. We included data on subjects eligible for FTIC between 08 Jan 2016 and 07 December 2016. We adjusted for pre-intervention differences using difference-in-differences (DiD) analyses controlling for site-level clustering.
Results: We enrolled 362 intervention and 368 control arm patients. Thirty-day ART initiation was 83% in the intervention and 82% in the control arm (RD 0.5%; 95% CI: 5.0% to 6.0%). After adjusting for baseline ART initiation differences and covariates using DiD we found a 6% increase in ART initiation associated with FTIC (RD 6.3%; 95% CI: 0.6% to 13.3%). We found a small decrease in viral suppression within 18 months (RD 2.8%; 95% CI: 9.8% to 4.2%) with no difference after adjustment (RD: 1.9%; 95% CI: 9.1% to 5.4%) or when considering only those with a viral load recorded (84% intervention vs. 86% control). We found reduced crude 6-month retention in intervention sites (RD 7.2%; 95% CI: 14.0% to 0.4%). However, differences attenuated by 12 months (RD: 3.6%; 95% CI: 11.1% to 3.9%). Qualitative data showed FTIC counseling
was perceived as beneficial by patients and providers.

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