Abstract
BackgroundSub-optimal adherence to antiretroviral therapy (ART) is reportedly worse amongst young people living with HIV (YPLHIV). Group adherence counselling can be useful to improve adherence.ObjectivesWe evaluated an enhanced adherence counselling group intervention (EACGI) amongst YPLHIV failing a non-nucleoside reverse transcriptase (NNRTI)-based first-line ART regimen.MethodThis was a retrospective cohort study using routinely collected data of YPLHIV failing NNRTI-based first-line ART. Patients with confirmed virological failure were referred for EACGI, a 12-week curriculum of weekly, 1.5-h sessions accommodating 8–15 people per group. It aimed to facilitate readiness to switch to second-line ART and improve adherence through a mental health intervention. Viral loads of HIV were measured pre-EACGI; at baseline; 3, 6 and 12 months post switch.ResultsFifty-seven patients aged 13–25 years were invited to EACGI and followed for up to 48 weeks. Thirty-three (58%) patients attended at least four sessions, whilst 24 (42%) attended none. Amongst those who attended none, two (8%) were transferred out, three (13%) were lost to follow-up and two (8%) had died by week 48 of follow-up, whilst all who attended were still in care. By week 48, amongst patients still in care, 29%, 44% and 67% of those who attended no sessions, 4–9 and 10–12 sessions, respectively, had viral loads of < 50 copies/mL.ConclusionAn EACGI is a promising intervention for YPLHIV failing ART prior to treatment switch, leading to improved adherence. This study’s findings support the need for further enquiry into rigorous, evidence-based multilevel adherence interventions that are acceptable and effective for YPLHIV.
Highlights
Sub-optimal adherence to antiretroviral therapy (ART) amongst people living with HIV (PLHIV) is the leading cause of virological failure (VF).[1,2]
We report virological suppression outcomes amongst adolescents and young people who were invited to an Enhanced Adherence Counselling Group Intervention (EACGI) after failing a nonnucleoside reverse transcriptase (NNRTI) based first-line ART regimen
Main reasons reported by patients for a low attendance rate to EACGI amongst those who attended were hopelessness, family dysfunction, perception of not having an illness, an aversion to a daily routine attached to stigma and prior experience of medication side effects
Summary
Sub-optimal adherence to antiretroviral therapy (ART) amongst people living with HIV (PLHIV) is the leading cause of virological failure (VF).[1,2] This is reported to be more pronounced in young people and to some extent ‘characteristic’ during this growth phase.[3,4,5,6] Young people are a diverse group of the population and are defined in this study to be in the age range of 13–25 years.
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