Impact of Motivational Enhanced Adherence Counseling and Point-of-Care Viral Load Monitoring on Viral Load Outcome in Women on Life-Long ART: A Randomized Pilot Study
We piloted the combined effectiveness of point-of-care viral load monitoring plus motivational enhanced adherence counseling (intervention) compared with routine care (control) in women identified at risk of virologic failure in the PROMOTE study in Zimbabwe. In an unblinded randomized study, consen...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Hindawi Limited
2022-01-01
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| Series: | AIDS Research and Treatment |
| Online Access: | http://dx.doi.org/10.1155/2022/4887202 |
| _version_ | 1798036375216324608 |
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| author | Mercy T. Mutambanengwe-Jacob Charles C. Maponga K. Rivet Amico Bernard Ngara Nonhlanhla Yende-Zuma Tariro D. Chawana Teacler Nematadzira Justice F. Gumbo Tendayi Goverayi Petronella Matibe Bernadette V. Malunda Jim Aizire Taha E. Taha Mary G. Fowler Lynda Stranix-Chibanda |
| author_facet | Mercy T. Mutambanengwe-Jacob Charles C. Maponga K. Rivet Amico Bernard Ngara Nonhlanhla Yende-Zuma Tariro D. Chawana Teacler Nematadzira Justice F. Gumbo Tendayi Goverayi Petronella Matibe Bernadette V. Malunda Jim Aizire Taha E. Taha Mary G. Fowler Lynda Stranix-Chibanda |
| author_sort | Mercy T. Mutambanengwe-Jacob |
| collection | DOAJ |
| description | We piloted the combined effectiveness of point-of-care viral load monitoring plus motivational enhanced adherence counseling (intervention) compared with routine care (control) in women identified at risk of virologic failure in the PROMOTE study in Zimbabwe. In an unblinded randomized study, consenting women with last viral load ≥200 copies/ml and/or pill count outside 90–110% range were randomized 1 : 1 to receive the intervention or continue routine care, comprising laboratory-based VL monitoring and standard EAC, from trained nurses and counsellors. Viral load was measured 0, 3, 6, and 12 months after enrolment. We compared viral suppression <200 copies/ml at 6 and 12 months between the arms through Fisher’s exact test and sought associated factors by logistic regression with a 95% confidence interval (CI). Between December 2018 and July 2019, 50 women were enrolled (25 intervention and 25 controls) and followed until November 2020. At entry, 60% of the women were virally suppressed, 52% intervention vs. 68% control arm. Viral suppression was balanced between the two arms (p value = 0.248). At month 6 post study entry (primary endpont), 64% of the women retained in care were virally suppressed, 54% intervention vs. 76% control arm (p value = 0.124). At month12 post study entry (secondary endpoint), 69% of the women retained in care were virally suppressed, 67% intervention vs. 71% control arm women (p value = 0.739). More intervention women completed all scheduled sessions by month 6. Control group women were more likely to be virally suppressed at both timepoints. Only 25% had treatment switch by 12 months. Despite intense adherence support and viral load monitoring, sustained viral suppression remained elusive in women identified at risk of viral failure. These findings highlight the continued need for effective adherence intervention for women with unsuppressed HIV viral loads, efficient treatment switch strategies, as well as drug level monitoring. |
| first_indexed | 2024-04-11T21:12:00Z |
| format | Article |
| id | doaj.art-7b5ee4d0676f436da1d6d63cfecc8da3 |
| institution | Directory Open Access Journal |
| issn | 2090-1259 |
| language | English |
| last_indexed | 2024-04-11T21:12:00Z |
| publishDate | 2022-01-01 |
| publisher | Hindawi Limited |
| record_format | Article |
| series | AIDS Research and Treatment |
| spelling | doaj.art-7b5ee4d0676f436da1d6d63cfecc8da32022-12-22T04:02:59ZengHindawi LimitedAIDS Research and Treatment2090-12592022-01-01202210.1155/2022/4887202Impact of Motivational Enhanced Adherence Counseling and Point-of-Care Viral Load Monitoring on Viral Load Outcome in Women on Life-Long ART: A Randomized Pilot StudyMercy T. Mutambanengwe-Jacob0Charles C. Maponga1K. Rivet Amico2Bernard Ngara3Nonhlanhla Yende-Zuma4Tariro D. Chawana5Teacler Nematadzira6Justice F. Gumbo7Tendayi Goverayi8Petronella Matibe9Bernadette V. Malunda10Jim Aizire11Taha E. Taha12Mary G. Fowler13Lynda Stranix-Chibanda14Department of Pharmacy and Pharmaceutical SciencesDepartment of Pharmacy and Pharmaceutical SciencesDepartment of Health Behavior and Health EducationDepartment of Primary Health Care SciencesCentre for the AIDS Program of Research in South Africa (CAPRISA)University of Zimbabwe Clinical Trials Research CentreUniversity of Zimbabwe Clinical Trials Research CentreUniversity of Zimbabwe Clinical Trials Research CentreUniversity of Zimbabwe Clinical Trials Research CentreUniversity of Zimbabwe Clinical Trials Research CentreUniversity of Zimbabwe Clinical Trials Research CentreDepartment of EpidemiologyDepartment of EpidemiologyDepartment of PathologyUniversity of Zimbabwe Clinical Trials Research CentreWe piloted the combined effectiveness of point-of-care viral load monitoring plus motivational enhanced adherence counseling (intervention) compared with routine care (control) in women identified at risk of virologic failure in the PROMOTE study in Zimbabwe. In an unblinded randomized study, consenting women with last viral load ≥200 copies/ml and/or pill count outside 90–110% range were randomized 1 : 1 to receive the intervention or continue routine care, comprising laboratory-based VL monitoring and standard EAC, from trained nurses and counsellors. Viral load was measured 0, 3, 6, and 12 months after enrolment. We compared viral suppression <200 copies/ml at 6 and 12 months between the arms through Fisher’s exact test and sought associated factors by logistic regression with a 95% confidence interval (CI). Between December 2018 and July 2019, 50 women were enrolled (25 intervention and 25 controls) and followed until November 2020. At entry, 60% of the women were virally suppressed, 52% intervention vs. 68% control arm. Viral suppression was balanced between the two arms (p value = 0.248). At month 6 post study entry (primary endpont), 64% of the women retained in care were virally suppressed, 54% intervention vs. 76% control arm (p value = 0.124). At month12 post study entry (secondary endpoint), 69% of the women retained in care were virally suppressed, 67% intervention vs. 71% control arm women (p value = 0.739). More intervention women completed all scheduled sessions by month 6. Control group women were more likely to be virally suppressed at both timepoints. Only 25% had treatment switch by 12 months. Despite intense adherence support and viral load monitoring, sustained viral suppression remained elusive in women identified at risk of viral failure. These findings highlight the continued need for effective adherence intervention for women with unsuppressed HIV viral loads, efficient treatment switch strategies, as well as drug level monitoring.http://dx.doi.org/10.1155/2022/4887202 |
| spellingShingle | Mercy T. Mutambanengwe-Jacob Charles C. Maponga K. Rivet Amico Bernard Ngara Nonhlanhla Yende-Zuma Tariro D. Chawana Teacler Nematadzira Justice F. Gumbo Tendayi Goverayi Petronella Matibe Bernadette V. Malunda Jim Aizire Taha E. Taha Mary G. Fowler Lynda Stranix-Chibanda Impact of Motivational Enhanced Adherence Counseling and Point-of-Care Viral Load Monitoring on Viral Load Outcome in Women on Life-Long ART: A Randomized Pilot Study AIDS Research and Treatment |
| title | Impact of Motivational Enhanced Adherence Counseling and Point-of-Care Viral Load Monitoring on Viral Load Outcome in Women on Life-Long ART: A Randomized Pilot Study |
| title_full | Impact of Motivational Enhanced Adherence Counseling and Point-of-Care Viral Load Monitoring on Viral Load Outcome in Women on Life-Long ART: A Randomized Pilot Study |
| title_fullStr | Impact of Motivational Enhanced Adherence Counseling and Point-of-Care Viral Load Monitoring on Viral Load Outcome in Women on Life-Long ART: A Randomized Pilot Study |
| title_full_unstemmed | Impact of Motivational Enhanced Adherence Counseling and Point-of-Care Viral Load Monitoring on Viral Load Outcome in Women on Life-Long ART: A Randomized Pilot Study |
| title_short | Impact of Motivational Enhanced Adherence Counseling and Point-of-Care Viral Load Monitoring on Viral Load Outcome in Women on Life-Long ART: A Randomized Pilot Study |
| title_sort | impact of motivational enhanced adherence counseling and point of care viral load monitoring on viral load outcome in women on life long art a randomized pilot study |
| url | http://dx.doi.org/10.1155/2022/4887202 |
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