Effectiveness of community adolescent treatment supporters (CATS) interventions in improving linkage and retention in care, adherence to ART and psychosocial well-being: a randomised trial among adolescents living with HIV in rural Zimbabwe

Nicola Willis,Mather Mawodzeke,Alice Armstrong,Innocent Yekeye,Chengetai Dziwa,Victoria James,Amos Milanzi,Phangisile Mtshali

doi:10.1186/s12889-019-6447-4

Nicola Willis, Mather Mawodzeke + Show 6 more

Open Access

https://doi.org/10.1186/s12889-019-6447-4

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Abstract

BackgroundEngagement with community adolescent treatment supporters (CATS) improves adherence, psychosocial well-being, linkage and retention in care among adolescents living with HIV. However, there is an urgent need for empirical evidence of the effectiveness of this approach, in order to inform further programmatic development, national and international policy, guidelines and service delivery for adolescents living with HIV. This study set out to determine the effectiveness of CATS services on improving linkage to services and retention in care, adherence and psychosocial well-being among adolescents living with HIV in Zimbabwe.MethodsA randomised trial was conducted in Gokwe South district, Zimbabwe over a period of 12 months. Ninety-four HIV-positive adolescents, 10–15 years old, on antiretroviral therapy were recruited to the study. 47 participants received standard of care from the Ministry of Health and Child Care and 47 received the same standard of care plus CATS services. Data collection involved a questionnaire which was administered at baseline then repeated at three, six, nine and twelve months for all participants. Survey questions on confidence, self-esteem and self-worth had a three-point Likert scale. Stigma, quality of life and the linkages to services and retention questions had a five-point Likert scale.ResultsSurvey questionnaires were completed with response rates of 40 out of 47 (85%) for the intervention arm, and 28 out of 47 (60%) for the control arm, at end-line. The intervention group were 3.9 times more likely to adhere to treatment compared to the control group. Linkage to services and retention in care within the intervention group increased compared with a decrease in the control arm. The intervention group reported a statistically significant increase in confidence, self-esteem, self-worth (p < 0.001) and quality of life compared (p = 0.028) with a decrease in the control arm.ConclusionsThis study found that adolescents receiving the CATS service had improved linkage to services and retention in care, improved adherence and improved psychosocial well-being compared to adolescents who did not have access to such services.Trial registrationPACTR201711002755428. Registered 11 November 2017. Retrospectively registered.

Highlights

Engagement with community adolescent treatment supporters (CATS) improves adherence, psychosocial well-being, linkage and retention in care among adolescents living with Human immunodeficiency virus (HIV)
This study found that adolescents receiving the CATS service had improved linkage to services and retention in care, improved adherence and improved psychosocial well-being compared to adolescents who did not have access to such services
There are an estimated 1.8 million adolescents living with HIV (ALHIV) worldwide, of which 82% live in sub-Saharan Africa [1]

Summary

Introduction

Engagement with community adolescent treatment supporters (CATS) improves adherence, psychosocial well-being, linkage and retention in care among adolescents living with HIV. Like other countries in the region, has scaled up initiatives to promote case finding, earlier diagnosis and ART initiation, resulting in an estimated 80% of ALHIV on ART [6] Despite this success of ART for adolescents, AIDS-related deaths among this age group are not declining and remain among the leading causes of death for this age group in sub-Saharan Africa [7, 8]. Studies have indicated that ALHIV have an increased risk of poor mental health outcomes such as depression [11], which is itself associated with poor adherence [12] Recognising these challenges for ALHIV, the 2016 WHO consolidated ART guidance recommends that community-based interventions which support ART adherence and retention in care should integrate psychosocial support and engage peers in service delivery [5, 13]. There is a critical need for further evidence of the effectiveness of peer-led community services for ALHIV, for those living in rural settings as most literature to date has focused on urban settings

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