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Multimedia technologies offer powerful tools to increase capacity of health workers to deliver standardized, effective, and engaging antiretroviral medication adherence counseling. Masivukeni-is an innovative multimedia-based, computer-driven, lay counselor-delivered intervention designed to help people living with HIV in resource-limited settings...
Contexts in source publication
Context 1
... assessment battery was developed by a combined US-South Africa team of investigators in accordance with Social Action Theory (SAT; see Figure 1) [35,36], which posits that behavioral health outcomes are mediated by contextual factors (e.g., demographics, health care systems, and mental health) and by self-and social-regulation factors (e.g., self-efficacy, health beliefs, social relationships, and stigma). All measures were translated from English into Xhosa and back-translated by linguistic experts at the University of Cape Town. ...
Context 2
... assessment battery was developed by a combined US-South Africa team of investigators in accordance with Social Action Theory (SAT; see Figure 1) [35,36], which posits that behavioral health outcomes are mediated by contextual factors (e.g., demographics, health care systems, and mental health) and by self-and social-regulation factors (e.g., self-efficacy, health beliefs, social relationships, and stigma). All measures were translated from English into Xhosa and back-translated by linguistic experts at the University of Cape Town. They were also reviewed by Xhosa-speaking study staff to ensure accurate and meaningful translations. All assessments were administered by trained research ...
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Background
Treatment adherence is critical for the success of antiretroviral therapy (ART) for people living with HIV. There is limited representative information on ART drug adherence and its associated factors from Southern Ethiopia. We aimed at estimating the level of adherence to ART among people living with HIV and factors associated with it i...
Citations
... Furthermore, community-based interventions tend to involve public health workers and peers who help with counseling and support for achieving and maintaining good ART adherence [27,[34][35][36][37]. HIV interventions in primary healthcare can also reduce stigma, discrimination, and other factors that may lead to improved health outcomes for PWH [38]. ...
Objective:
: To estimate and compare the cost of improved test and treat strategies in Indonesia under HIV Awal (Early) Testing and Treatment Indonesia (HATI) implementation trial in community-based and hospital-based clinics.
Design:
: The cost and outcome [i.e. CD4+ cell count] and viral load (VL) at the beginning of interventions and their change overtime) analysis of Simplifying ART Initiation (SAI), Community-based Organization and community-based ART Service (CBO), Motivational Interviewing (MI), Oral Fluid-based Testing (OFT), and Short Message Service (SMS) reminder in community-based and hospital-based clinics in 2018-2019.
Method:
We estimated the total and unit costs per patient (under HATI implementation trial interventions) per year from societal perspective in various settings, including costs from patients' perspective for SAI and MI. We also analyzed the outcome variables (i.e. CD4+ cell count and VL at the beginning of each intervention, the change in CD4+ and VL overtime, and adherence rate).
Result:
The unit cost per patient per year of SAI and SMS were lower at the community-based clinics, and more patients visited community-based clinics. The cost per patient visit from patient perspective for SAI and MI was mostly lower than 10% of the patients' household monthly expenditure. Average CD4+ was higher and average VL was lower at the start of interventions at the community-based clinics, while average CD4+ and VL changes and adherence rate were similar between the two types of clinics.
Conclusion:
Community-based clinics hold the potential for scaling up the interventions as it costs less from societal perspective and showed better outcome improvement during the HATI implementation trial.
... 36 Table 2 summarises the characteristics of the included studies, and Table 3 Identification and description of the studies WHO classification of digital health interventions. There were 13 studies [40][41][42][43][44][45][46][47][48]51,53,57,58 with digital health interventions targeted at clients as primary users and 12 studies [35][36][37][38][39]49,50,52,[54][55][56]59 with interventions targeted at healthcare providers as primary users. There were no digital health interventions targeted at health system managers or data services. ...
... For digital health interventions targeted at clients, targeted client communication 41,42,46,48 and client-to-client communication 40,53,57,58 were the most common ways clients accessed palliative care. Using the WHO classification, the digital health interventions used to provide palliative care to PLWH in SSA were categorised into 9 categories: targeted client communication, 41,42,46,48 client to client communication, 40,53,57,58 personal health tracking, 43,44,47 citizen-based reporting, 45 on-demand information services to clients, 51 health care provider decision support, 50,56,59 telemedicine, [35][36][37][38][39]49,54 referral coordination, and laboratory and diagnostics imaging management. 55 Across all approaches, telemedicine was the most commonly reported in the included studies [35][36][37][38][39]49,54 (see Table 4). ...
... The second largest number of studies (n = 10) 35,36,38,40,44,46,47,51,58,59 were at the feasibility and piloting stage. The largest number of studies (n = 12) 37,39,[41][42][43]49,50,[53][54][55][56][57] were at the ...
BACKGROUND: In 2018, 26.6 million people were living with HIV (PLWH) in Sub-Saharan Africa (SSA). Palliative care services are recommended for PLWH at all stages from diagnosis through to end-of-life. However, provision of palliative care in SSA is limited leading to little or no access for the majority of patients. Digital technologies in SSA present an opportunity to improve access to palliative care for PLWH in the region. This review synthesised literature on digital health interventions (DHIs) for palliative care for PLWH in SSA and assessed their effects on patient outcomes.
METHODS: Literature searches were conducted in MEDLINE, Embase, PsycINFO and Global Health. Inclusion and exclusion criteria were applied. Two independent reviewers conducted study screening, data extraction and quality appraisal. A narrative synthesis was performed to draw together and report findings across heterogeneous studies. Reporting of this review follows the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) checklist.
RESULTS: Out of 4,117 records, 25 studies were included covering 3,592 PLWH, across 21 countries. Studies included three randomised controlled trials, three qualitative, three pre-and-post-test, two observational, two case series, six cross-sectional and six mixed methods studies. Telemedicine was the most reported DHI, with twelve studies demonstrating the effectiveness of DHIs.
CONCLUSION: Emerging evidence suggests DHIs can be effective in facilitating patient-provider communication and health professional decision-making as part of palliative care for PLWH. There is a need for further development and evaluation of DHIs alongside determining optimal approaches to their implementation as part of palliative care provision in SSA.
... Prior studies have provided mixed evidence about the association between social support and adherence to ART. Some literature suggests that SSI may increase adherence to ART [10,[12][13][14][15], others suggest null or very small effects of SSI on improving adherence [21][22][23][24][25]. ...
... The studies defined adherence to ART and its measures in different ways. Ten studies (59%) measured adherence using subjective measures [12, 16, 21-24, 28, 30-32], three studies (18%) used objective measures (pill counts or pharmacy records) [13,14,34], with the rest (23%) used both self-reported and objective measures [15,25,29,33]. Table 1. ...
... A summary of the SSIs are reported in Table 2. Interventions varied by source of support, type of support, and methods used to assess social support. Of the 17 included studies, seven (41%) used a peers/friends SSI [15,22,25,28,29,32,34], two (12%) used family/caregivers [14,24], one (6%) used HIV-experienced clinicians SSI [12], and There was good agreement between the two reviewers concerning the methodological quality. ...
This systematic review and meta-analysis examined the effects of social support interventions (SSIs) on adherence to antiretroviral therapy (ART) among people living with HIV. We systematically searched Web of Science, PubMed/MEDLINE, Scopus, and Cochrane Library in September 9, 2020. English-language publications of randomized controlled trials (RCTs) in peer-reviewed journals were considered eligible. To estimate the effects of SSIs on adherence to ART, odds ratios (ORs) with 95% confidence intervals (CIs) were pooled using random effects models. Subgroup analysis was used to investigate the sources of heterogeneity. Of 243 records identified, 17 controlled trials were included. The meta-analysis found significant and moderate effect size in the improvement of adherence to ART from SSIs. Subgroup analysis showed that the study design, follow up duration, source of social support, and year of publication significantly moderated the effect sizes in the meta-analysis. Our findings support the hypothesis that social support interventions can improve adherence to ART. Using various types and sources of social support, further research is needed to assess the effect of SSIs on adherence to ART across different settings.
... Despite these encouraging findings, gaps in knowledge remain. Masivukeni, for example, was designed for patienttreatment supporter dyads but not specifically couples, and utilized a technology-based approach, which may not be feasible in resource-poor or rural settings such as Malawi [22]. Furthermore, few interventions with couples have been designed to improve behaviors related to the post-HIV infection care continuum. ...
... In Masivukeni ("Let's Wake Up"), dyads (patients and treatment supporters) engaged in multimedia education, structured discussions, problem-solving, and communication exercises maintained high levels of ART adherence. Pilot data showed a 10% improvement in adherence in the experimental group, compared to an 8% decrease in adherence for the control group [22]. A second intervention, Uthando Lwethu ("Our Love"), aimed to increase uptake of couples' HIV testing by improving relationship dynamics (e.g., intimacy, trust) and problem-solving skills [23]. ...
... Indeed, research comparing different measures of adherence shows that participants are prone to recall and social desirability bias in their self-reports [21]. Specifically, while self-report is quite good at identifying very poor adherence, it is less accurate for distinguishing between moderate non-adherence (not severe) and good adherence [22]. By this reasoning, it is possible that a single factorsuch as social desirability bias or optimism-could contribute to over-reporting of good ART adherence and positive relationship status, explaining the correlation between the two. ...
Couple relationships can be leveraged to improve adherence to antiretroviral therapy (ART), but few studies have identified relationship factors to target in interventions in sub-Saharan Africa. We conducted a cross-sectional study with 211 couples in southern Malawi with at least one partner on ART to test for associations between ART adherence and relationship dynamics (intimacy, trust, relationship satisfaction, unity, commitment, and partner support). We measured ART adherence through subjective measures (patient and partner reports) and an objective measure (ART drug levels in hair) and hypothesized that more positive relationship dynamics (e.g., higher intimacy) would be associated with better adherence. Multi-level logistic and linear regression models were used to evaluate study hypotheses, controlling for the clustering of individuals within couples. High levels of adherence were found by all three measures. Unity, satisfaction, and partner support were associated with higher patient and partner reports of adherence, and additional relationship dynamics (intimacy, trust) were associated with higher partner reported adherence. No associations were found between relationship dynamics and drug levels in hair, although drug levels were high overall. Future studies should perform longitudinal assessments of relationship dynamics and objective metrics of adherence, and examine these associations in populations with lower adherence levels such as young women or individuals starting ART.
... The intervention arm had more likelihood of adhering to ART than the control arm. The study designs consisted of ten cohort studies [24,25,29,33,34,37,38,47,52,53], four pre-post studies [26,28,35,36], sixteen randomized controlled trials [27,31,32,[39][40][41][42][43][44][45][46][48][49][50][51]54], and only one cross-sectional study [30]. ...
... The intervention categories as described on Table 2 comprised of structural intervention [24,26,29,[32][33][34][35]51], which involved intervention types such as community health worker's home visits [24], community-based support (CBAS) groups [24,33], option B+ [25], mobile pharmacy [34], semi-mobile clinics [35], micro clinics, and community-based care by personal digital assistant [51]. Interventions that were within the affective category [24][25][26][27][28]30,31,[41][42][43][44]50,54] included counseling [27,28,38,43], peer support groups [30], adherence treatment supporter [37,42], and psychotherapy [46]. Interventions in the cognitive category [39,40,49,50] involved patient education [39] and active visualization [40]. ...
... Interventions that were within the affective category [24][25][26][27][28]30,31,[41][42][43][44]50,54] included counseling [27,28,38,43], peer support groups [30], adherence treatment supporter [37,42], and psychotherapy [46]. Interventions in the cognitive category [39,40,49,50] involved patient education [39] and active visualization [40]. Interventions in the behavioral category [24,25,29,31,32,41,44,45,47,48,54] involved appointment diary [29], cell phone adherence sessions [41], and text messaging [45,48] while the biological category [52,53] was made of the food ration [52] and food assistance [53]. ...
Optimal adherence to antiretroviral therapy (ART) remains the bedrock of effective therapy and management of human immunodeficiency virus (HIV). This systematic review examines the effect of interventions in improving ART adherence in sub-Saharan Africa (SSA), which bears the largest global burden of HIV infection. In accordance with PRISMA guidelines, and based on our inclusion and exclusion criteria, PUBMED, MEDLINE, and Google Scholar databases were searched for published studies on ART adherence interventions from 2010 to 2019. Thirty-one eligible studies published between 2010 to 2019 were identified, the categories of interventions were structural, behavioral, biological, cognitive, and combination. Study characteristics varied across design, intervention type, intervention setting, country, and outcome measurements. Many of the studies were behavioral interventions conducted in hospitals with more studies being randomized controlled trial (RCT) interventions. Despite the study variations, twenty-four studies recorded improvements. Notwithstanding, more quality studies such as RCTs should be conducted, especially among key affected populations (KAPs) to control transmission of resistant strains of the virus. Reliable objective measures of adherence should replace the conventional subjective self-report. Furthermore, long-term interventions with longer duration should be considered when evaluating the effectiveness of interventions.
... It was a randomized experimental study. Sample size calculation was based on the result from Robbins RN, et al. [16] as medical adherence was assessed using pill count method. Eighty eight subjects were randomized into control and study groups using a random number table that resulted in equal sample sizes (N of each=44). ...
... A number of studies have been attempting to integrate technologies into the counseling given by healthcare providers in HIV clinics. The technologies were tested and showed the effectiveness [16,[18][19][20][21][22][23][24] . However, such technologies are sometimes impractical to be used because of difference of the HIV clinic. ...
... Subjects in study group had significantly higher knowledge test scores regarding HIV infection and antiretroviral drugs, coinciding with previous reports suggesting that integrating technology into the counseling better improved the knowledge in patients not doing so [16,21] . Interestingly, this knowledge scores were not decreased after the period of 1 mo, in accordance with the study of Turk et al. [11] , suggesting that "infographic affects the long-term memory". ...
... Interventions like Masivukeni offer opportunities to improve access to standardized ART adherence counselling and enhance LCs capacity to deliver interventions [13]. However, low-resource healthcare settings present challenges to wider mHealth implementation because of issues such as limited funding, high costs, and poor infrastructure -factors known to impede the process of implementation [10,14]. ...
... Finally, the LCs revealed that their counselling space was sometimes inadequate and not always private, compromising on confidentiality. While this barrier may not be specific to Masivukeni, lack of available resources, such as physical space, may hinder potential implementation of interventions in general [6,7,13]. However, as an example of a tailored mHealth intervention, Masivukeni may be able fill the need for standardized ART adherence practices [2,3]. ...
Background: Persons living with HIV (PLWH) in South Africa's expanding antiretroviral treatment (ART) program receivereadiness counselling provided by Lay Counsellors (LCs). Both the delivery of content and counselling approach are difficult tostandardize across multiple sites and providers. mHealth applications offer an opportunity in low resource settings to addressthese needs.
Objective: The objective of this study was to explore the perceived pre-implementation barriers and facilitators of an mHealthintervention (“Masivukeni”) among staff at a large Cape Town-based HIV care non-profit organisation.Methods: Seven interviews and three focus groups were conducted with experienced LCs, their supervisors and managers. We used the Consolidated Framework for Implementation Research (CFIR) to explore perceived implementation barriers and facilitators of the Masivukeni intervention.
Results: Several potential facilitators of Masivukeni were identified, most notably interactive learning and facilitated updates. Barriers to implementation included security risks and costs of equipment, the high volume of patients needing to be counselled and variable computer literacy.
Conclusions: mHealth applications, such as Masivukeni, were perceived as being well-placed to address some needs of those who deliver ART adherence counselling in South Africa. However, the successful implementation of mHealth applications appeared to be dependent on overcoming certain barriers in this setting.
... Modules are presented in a linear fashion; they can be represented at any time and are delivered in a visual and interactive manner to improve patient interaction and reduce the effect of low literacy levels [7]. Interventions such as Masivukeni offer opportunities to improve access to standardized ART adherence counseling and enhance LCs' capacity to deliver interventions [13]. However, low-resource health care settings present challenges to wider mHealth implementation because of issues such as limited funding, high costs, and poor infrastructure-factors known to impede the implementation process [10,14]. ...
... Finally, the LCs revealed that their counseling space was sometimes inadequate and not always private, compromising on confidentiality. Although this barrier may not be specific to Masivukeni, lack of available resources, such as physical space, may hinder the potential implementation of interventions in general [6,7,13]. However, as an example of a tailored mHealth intervention, Masivukeni may be able to fill the need for standardized ART adherence practices [2,3]. ...
Background
South Africa adopted a universal test and treatment program for HIV infection in 2015. The standard of care that people living with HIV receive consists of 3 sessions of readiness counseling delivered by lay counselors (LCs). In the largest antiretroviral therapy (ART) program worldwide, effective and early HIV and ART education and support are key for ensuring ART adoption, adherence, and retention in care. Having LCs to deliver readiness counseling allows for the wide task-sharing of this critical activity but carries the risks of loss of standardization, incomplete content delivery, and inadequate monitoring and supervision. Systems for ensuring that a minimum standard of readiness counseling is delivered to the growing number of people living with HIV are essential in the care cascade. In resource-constrained, high-burden settings, mobile health (mHealth) apps may potentially offer solutions to these treatment gaps by providing content structure and delivery records.
Objective
This study aims to explore, at a large Cape Town–based nonprofit HIV care organization, the staff’s perceived preimplementation barriers and facilitators of an mHealth intervention (Masivukeni) developed as a structured app for ART readiness counseling.
Methods
Masivukeni is a laptop-based app that incorporates written content, graphics, short video materials, and participant activities. In total, 20 participants were included in this study. To explore how an mHealth intervention might be adopted across different staff levels within the organization, we conducted 7 semistructured interviews (participants: 7/20, 35%) and 3 focus groups (participants in 2 focus groups: 4/20, 20%; participants in 1 focus group: 3/20, 15%) among LCs, supervisors, and their managers. In total, 20 participants were included in this study. Interviews lasted approximately 60 minutes, and focus groups ranged from 90 to 120 minutes. The Consolidated Framework for Implementation Research was used to explore the perceived implementation barriers and facilitators of the Masivukeni mHealth intervention.
ResultsSeveral potential facilitators of Masivukeni were identified. Multimedia and visual elements were generally regarded as aids in content delivery. The interactive learning components were notably helpful, whereas facilitated updates to the adherence curriculum were important to facilitators and managers. The potential to capture administrative information regarding LC delivery and client logging was regarded as an attractive feature. Barriers to implementation included security risks and equipment costs, the high volume of clients to be counseled, and variable computer literacy among LCs. There was uncertainty about the app’s appeal to older clients.
ConclusionsmHealth apps, such as Masivukeni, were perceived as being well placed to address some of the needs of those who deliver ART adherence counseling in South Africa. However, the successful implementation of mHealth apps appeared to be dependent on overcoming certain barriers in this setting.
... They also accompany PLWHs to clinic appointments and social support groups that provide emotional support, and at times they pick and deliver medication to the homes of PLWHs (Kunutsor et al., 2011;Nachega et al., 2009;Nakamanya et al., 2019). Studies indicate that treatment supporters promote healthy living, minimize the psychological stress associated with living HIV, and help PLWH reduce alcohol and drug use, leading to better health outcomes and survival (Nachega et al., 2009;Duwell et al., 2013;Robbins et al., 2015). Further, TSIs promote patient autonomy, improve individual social networks, and bridge medication, patient and structural barriers to treatment adherence (Kredo et al., 2013). ...
This systematic review and meta-analysis evaluated the effectiveness of treatment supporter interventions (TSI) in improving ART adherence and viral suppression among adults living with HIV (PLWH) in sub-Saharan Africa. This review included ten randomized controlled trials (RCT) and six cohort studies comparing treatment support interventions to the standard of care (SOC). Primary outcomes include pill count ART adherence and viral load suppression (VLS). Pooled relative risk ratios (PRR) with 95% confidence intervals were generated using random-effects models. Stratified analyses and meta-regressions were conducted to determine the effect of study type, follow-upperiod, and patient treatment supporters on ART adherence. Treatment supporters included partners, friends, family members, trained community health workers, and HIV positive peers. TSIs were associated with a 7.6% higher ART adherence compared to the SOC group (PRR = 1.076, [95% CI = 1.005, 1.151]). VLS was 5% higher in the treatment group compared to the SOC group (PRR = 1.05, [95% CI = 1.061, 1.207]). There was a significant, positive association between TSIs and VLS in community-based delivery settings but not in facility-based settings. TSIs were statistically significant for VLS in cohort study designs (RR = 1.073, [95% CI = 1.028, 1.121]) but not in RCTs. Findings suggest that TSIs critical in facilitating optimal ART adherence and VLS among PLWHs.
... Individuals randomized to the coached-based MEI receive weekly telephonic and app-based support and a structured face-to-face meeting every 3 months, augmented by the ongoing implementation of the study's mobile app. Telephonic and in-person supportive consultations are goal focused and designed to enhance linkage, ART initiation, adherence, and retention in care for MSM diagnosed with HIV [74][75][76]. The MEI coach is trained in and utilizes Rogerian listening skills, MI, SBIRT for substance use, and personal health goal setting to best support assigned participants [77][78][79][80][81]. ...
Background: The U.S. National HIV/AIDS Strategy 2020 calls for: increasing access to care and improving outcomes of people
living with HIV; and targeting biomedical prevention efforts, including access to pre-exposure prophylaxis (PrEP) in communities where HIV is most heavily concentrated. Baltimore, MD, Washington, DC and Philadelphia, PA are disproportionately burdened by high rates of new cases of HIV infection, with highly elevated rates among young Black and Latinx men who have sex with men (YBLMSM) and transgender women (TW) aged 15 to 24. Objective: The three aims of the PUSH study focus on assessing the effectiveness of different strategies to identify the prevention and treatment continua of YBLMSM and YBLTW in the three cities (Aim 1); and using two embedded randomized controlled trials, experimentally examine the efficacy of a mobile enhanced coach-based intervention to achieve sustained
retention and engagement in HIV care among youth living with HIV (YLWH) who are not virally suppressed (Aim 2), and examine the uptake of and adherence to PrEP and other preventive behaviors (e.g., condom use) among youth at elevated-risk for HIV infection (Aim 3).
Methods: This study is a multi-phase mixed methods design. The first phase is formative, qualitative research with key informant interviews (KII) and focus group discussions to inform development and refinement of the methods utilized in the interventions. The second phase consists of evaluating multiple methods of recruitment including traditional venue-based outreach, clinic-based recruitment and modified respondent driven sampling with targeted seed identification. The third phase includes two embedded randomized controlled trials to examine the efficacy of a mobile enhanced coach-based intervention to achieve sustained retention and engagement in HIV care among YLWH who are not virally suppressed and examine the uptake of and adherence to PrEP and other preventive behaviors (e.g., condom use) among youth at elevated-risk for HIV infection. All
Participants complete a baseline socio-behavioral survey, rapid HIV-1 testing, and eligible youth are randomized to one of two study arms: mobile enhanced intervention with coach or standard of care. Participants are asked to complete a web-based survey and provide biologic specimens (HIV-1 RNA (viral load) in YLWH, or 4th generation HIV-1 antibody test in youth at-risk for HIV; and urine drug screen) at baseline and 3, 6 and 12 months. Results: Formative qualitative research was conducted in February, 2017 and July, 2017 and led to further refinement of recruitment and study methods. Aim 1 recruitment began September 2017 with subsequent enrollment into Aims 2 and 3. Recruitment is on-going with 520 participants screened and 402 (77.3%) enrolled. Of these, 159 are enrolled in two randomized trials: 36 HIV-positive not virally suppressed and 123 high-risk HIV-negative. Conclusions: This study has the potential to significantly impact the medical and substance use services provided to YBLMSM and YBLTW in the United States by making available rigorous scientific evidence outlining approaches and strategies that
improve uptake and engagement of YBLMSM and YBLTW in the HIV treatment and prevention cascade.
