TY - JOUR
T1 - Impact of SMS and peer navigation on retention in HIV care among adults in South Africa
T2 - results of a three-arm cluster randomized controlled trial
AU - Steward, Wayne T.
AU - Agnew, Emily
AU - de Kadt, Julia
AU - Ratlhagana, Mary Jane
AU - Sumitani, Jeri
AU - Gilmore, Hailey J.
AU - Grignon, Jessica
AU - Shade, Starley B.
AU - Tumbo, John
AU - Barnhart, Scott
AU - Lippman, Sheri A.
N1 - Funding Information:
This project was funded by Cooperative Agreement U91HA06801 from the US Department of Health and Human Services, Health Resources and Services Administration (HRSA) in support of the President’s Emergency Plan for AIDS Relief (PEPFAR). The contents of this paper are solely the responsibility of the authors and do not necessarily represent the views of HRSA or the U.S. Government. We thank Jay Gilvydis and Parya Saberi for input into the intervention design; Elsie Raphela for supporting community entry; Ndangano Makongoza for study coordination in Moses Kotane; Lebogang Isidoro, Doctor Khoza, Kenneth Sello and Seipati Kotosi for supervision of the peer navigators and Michael Reyes for mentorship and support. We also thank the individuals who served as our monitoring and evaluation assistants or peer navigators. We express sincere gratitude to the study participants. Finally, we thank the North West Provincial Department of Health, the Bojanala Platinum District Department of Health and the Provincial Research Committee for their support of this project.
Funding Information:
This project was funded by Cooperative Agreement U91HA06801 from the US Department of Health and Human Services, Health Resources and Services Administration (HRSA) in support of the President’s Emergency Plan for AIDS Relief (PEPFAR). The contents of this paper are solely the responsibility of the authors and do not necessarily represent the views of HRSA or the U.S. Government. We thank Jay Gilvydis and Parya Saberi for input into the intervention design; Elsie Raphela for supporting community entry; Ndangano Makongoza for study coordination in Moses Kotane; Lebogang Isidoro, Doctor Khoza, Kenneth Sello and Seipati Kotosi for supervision of the peer navigators and Michael Reyes for mentorship and support. We also thank the individuals who served as our monitoring and evaluation assistants or peer navigators. We express sincere gratitude to the study participants. Finally, we thank the North West Provincial Department of Health, the Bojanala Platinum District Department of Health and the Provincial Research Committee for their support of this project. Procedures were approved by institutional review boards at the University of California San Francisco, University of Washington and Human Sciences Research Council in South Africa. The North West Provincial Department of Health’s Policy, Planning, Research, Monitoring and Evaluation Committee also approved the protocol. Participants were enrolled between October 1, 2014 and April 30, 2015, and each was followed for one year. The trial was registered with ClinicalTrials.gov, NCT02417233, on 12 December 2014.
Publisher Copyright:
© 2021 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of International AIDS Society
PY - 2021/8
Y1 - 2021/8
N2 - Introduction: Few interventions have demonstrated improved retention in care for people living with HIV (PLHIV) in sub-Saharan Africa. We tested the efficacy of two personal support interventions – one using text messaging (SMS-only) and the second pairing SMS with peer navigation (SMS+PN) – to improve HIV care retention over one year. Methods: In a cluster randomized control trial (NCT# 02417233) in North West Province, South Africa, we randomized 17 government clinics to three conditions: SMS-only (6), SMS+PN (7) or standard of care (SOC; 4). Participants at SMS-only clinics received appointment reminders, biweekly healthy living messages and twice monthly SMS check-ins. Participants at SMS+PN clinics received SMS appointment reminders and healthy living messages and spoke at least twice monthly with peer navigators (PLHIV receiving care) to address barriers to care. Outcomes were collected through biweekly clinical record extraction and surveys at baseline, six and 12 months. Retention in HIV care over one year was defined as clinic visits every three months for participants on antiretroviral therapy (ART) and CD4 screening every six months for pre-ART participants. We used generalized estimating equations, adjusting for clustering by clinic, to test for differences across conditions. Results: Between October 2014 and April 2015, we enrolled 752 adult clients recently diagnosed with HIV (SOC: 167; SMS-only: 289; SMS+PN: 296). Individuals in the SMS+PN arm had approximately two more clinic visits over a year than those in other arms (p < 0.01) and were more likely to be retained in care over one year than those in SOC clinics (54% vs. 38%; OR: 1.77, CI: 1.02, 3.10). Differences between SMS+PN and SOC conditions remained significant when restricting analyses to the 628 participants on ART (61% vs. 45% retained; OR: 1.78, CI: 1.08, 2.93). The SMS-only intervention did not improve retention relative to SOC (40% vs. 38%, OR: 1.12, CI: 0.63, 1.98). Conclusions: A combination of SMS appointment reminders with personalized, peer-delivered support proved effective at enhancing retention in HIV care over one year. While some clients may only require appointment reminders, the SMS+PN approach offers increased flexibility and tailored, one-on-one support for patients struggling with more substantive challenges.
AB - Introduction: Few interventions have demonstrated improved retention in care for people living with HIV (PLHIV) in sub-Saharan Africa. We tested the efficacy of two personal support interventions – one using text messaging (SMS-only) and the second pairing SMS with peer navigation (SMS+PN) – to improve HIV care retention over one year. Methods: In a cluster randomized control trial (NCT# 02417233) in North West Province, South Africa, we randomized 17 government clinics to three conditions: SMS-only (6), SMS+PN (7) or standard of care (SOC; 4). Participants at SMS-only clinics received appointment reminders, biweekly healthy living messages and twice monthly SMS check-ins. Participants at SMS+PN clinics received SMS appointment reminders and healthy living messages and spoke at least twice monthly with peer navigators (PLHIV receiving care) to address barriers to care. Outcomes were collected through biweekly clinical record extraction and surveys at baseline, six and 12 months. Retention in HIV care over one year was defined as clinic visits every three months for participants on antiretroviral therapy (ART) and CD4 screening every six months for pre-ART participants. We used generalized estimating equations, adjusting for clustering by clinic, to test for differences across conditions. Results: Between October 2014 and April 2015, we enrolled 752 adult clients recently diagnosed with HIV (SOC: 167; SMS-only: 289; SMS+PN: 296). Individuals in the SMS+PN arm had approximately two more clinic visits over a year than those in other arms (p < 0.01) and were more likely to be retained in care over one year than those in SOC clinics (54% vs. 38%; OR: 1.77, CI: 1.02, 3.10). Differences between SMS+PN and SOC conditions remained significant when restricting analyses to the 628 participants on ART (61% vs. 45% retained; OR: 1.78, CI: 1.08, 2.93). The SMS-only intervention did not improve retention relative to SOC (40% vs. 38%, OR: 1.12, CI: 0.63, 1.98). Conclusions: A combination of SMS appointment reminders with personalized, peer-delivered support proved effective at enhancing retention in HIV care over one year. While some clients may only require appointment reminders, the SMS+PN approach offers increased flexibility and tailored, one-on-one support for patients struggling with more substantive challenges.
KW - South Africa
KW - peer navigation
KW - retention in care
KW - text messaging
UR - http://www.scopus.com/inward/record.url?scp=85114230641&partnerID=8YFLogxK
U2 - 10.1002/jia2.25774
DO - 10.1002/jia2.25774
M3 - Article
C2 - 34435440
AN - SCOPUS:85114230641
SN - 1758-2652
VL - 24
JO - Journal of the International AIDS Society
JF - Journal of the International AIDS Society
IS - 8
M1 - e25774
ER -