Effect of a ward-based outreach team and adherence game on retention and viral load suppression.

Abstract

Only 66% of South African people living with HIV (PLWH) are virologically suppressed. Therefore, it is important to develop strategies to improve outcomes. Assess the effect of interventions on 12-month retention in care and virological suppression in participants newly initiated on antiretroviral therapy. Fifty-seven clinics were randomised into four arms: Ward-based primary health care outreach teams (WBPHCOTs); Game; WBPHCOT-Game in combination; and Control (standard of care). Sixteen clinics were excluded and four re-allocated because lay counsellors and operational team leaders failed to attend the required training. Seventeen clinics were excluded due to non-enrolment. A total of 558 participants from Tshwane district were enrolled. After excluding ineligible participants, 467 participants were included in the analysis: WBPHCOTs (n = 72); Games (n = 126); WBPHCOT-Games (n = 85); and Control (n = 184). Retention in care at 12 months was evaluable in 340 participants (86.2%) were retained in care and 13.8% were lost to follow-up. The intervention groups had higher retention in care than the Control group, but this only reached statistical significance in the Games group (96.8% vs 77.8%; relative risk [RR] 1.25; 95% confidence interval [CI]: 1.13-1.38; P = 0.01). The 12 month virologic suppression rate was 75.3% and was similar across the four arms. This study demonstrated that an adherence game intervention could help keep PLWH in care. Evidence that interventions, especially Games, could improve retention in care.