Abstract
We evaluated the feasibility and efficacy of four existing interventions to improve adherence to them in migrants living with HIV (MLWH): directly administered antiretroviral therapy (DAART), group medical appointments (GMA), early detection and treatment of psychological distress, and peer support by trained MLWH. At baseline and after the interventions, socio-demographic characteristics, psychosocial variables, and data on HIV treatment adherence were collected. The two questionnaires were completed by 234/301 (78%) MLWH included at baseline. Detectable HIV RNA decreased (from 10.3 to 6.8%) as did internalized HIV-related stigma (from 15 to 14 points), and self-reported adherence increased (between 5.5 and 8.3%). DAART and GMA were not feasible interventions. Screening of psychological distress was feasible; however, follow-up diagnostic screening and linkage to psychiatric services were not. Peer support for and by MLWH was feasible. Within this small intervention group, results on HIV RNA < 400 copies/mL (decrease of 23.6%) and outpatient clinic attendance (up to 20.4% kept more appointments) were promising.
Highlights
Since the introduction of combination Antiretroviral Therapy in 1996, HIV infection has become a manageable chronic disease with a greatly improved life expectancy [1,2]
This study is embedded in the ROtterdam ADherence (ROAD) project, which is a quasiexperimental intervention study in which the primary aim was to increase adherence in firstand second-generation adult immigrant people living with HIV
The results demonstrate that directly administered antiretroviral therapy (DAART) and group medical appointments (GMA) are currently not feasible interventions within an migrants living with HIV (MLWH) population living in Western Europe
Summary
Since the introduction of combination Antiretroviral Therapy (cART) in 1996, HIV infection has become a manageable chronic disease with a greatly improved life expectancy [1,2]. Several factors have been associated with adherence to cART, including clinical appointment attendance and psychosocial factors such as HIV-related stigma, social support, psychological distress, and quality of life [3,4,5,6]. Migrants living with HIV (MLWH), who, in Europe, comprised 40% of all people diagnosed with HIV between 2008 and 2017 [7], have worse psychosocial and clinical outcomes. Specific risk factors for non-adherence to cART in MLWH include experiencing low social support, having low educational attainment, and experiencing low treatment adherence self-efficacy [13]. Because risk factors for non-adherence significantly influence treatment outcomes in MLWH, finding interventions that address risk factors for non-adherence to cART in this population is important
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