What: The Annual Conference on Retroviruses and Opportunistic InfectionsWhen: Feb. 13–16, 2017Where: Seattle, Washington, Washington State Convention Center(705 Pike St., Seattle, WA 98101)
****EMBARGOED FOR RELEASE UNTIL 2:30 P.M. P.S.T. ON FEB. 14****
Uptake and Adaption of Community Adherence Groups in Zambia
Presented during “Interventions to Improve the Care Cascade” – P – W2
Poster Number: 1004
Where: Poster Hall 4 EF
When: 2:30–4 p.m.
Newswise — Monika Roy, M.D., of the University of California, San Francisco, a trainee of Charles Holmes, M.D., M.P.H., associate professor of medicine at the Johns Hopkins University School of Medicine and board member for the Centre for Infectious Disease Research in Zambia, will present on the retention and outcomes of HIV patients in Zambia.
Holmes, Roy and colleagues from the University of California, San Francisco; the University of California, Berkeley; the University of Alabama; and the Centre for Infectious Disease Research in Zambia investigated whether a community-based HIV treatment model can facilitate continued treatment for HIV patients.
Retention is a major problem for clinics treating patients with HIV in Zambia. Patients in Zambian communities still face significant barriers to remaining in long-term HIV care, including access to transportation, time away from work, clinic wait times and conflicting priorities. Because of this, the study tested community-based HIV treatment models, called community adherence groups (CAGs), as a method to improve long-term retention in care. CAGs are made up of six established HIV patients who rotate visiting the clinic for individual monitoring and group medication pickup. They then distribute medications to their group at community meetings. This study revealed that an average of 90 percent of individuals offered entry into a CAG accepted this invitation, and 98 percent of groups were sustained through the first group meeting. This data suggest that the CAG model could succeed in increasing patient engagement in care while decreasing the burden on clinics.
****EMBARGOED FOR RELEASE UNTIL 2:30 P.M. P.S.T. ON FEB. 14****
IMPROVED RETENTION WITH LONGER FOLLOW-UP INTERVALS FOR STABLE PATIENTS IN ZAMBIA
Presented during “Interventions to Improve the Care Cascade” – P – W2
Poster Number: 1000
Where: Poster Hall 4 EF
When: 2:30–4 p.m.
Aaloke Mody, M.D., of the University of California, San Francisco, a trainee of Charles Holmes, M.D., M.P.H., associate professor of medicine at the Johns Hopkins University School of Medicine and board member for the Centre for Infectious Disease Research in Zambia, will present on the retention and outcomes of HIV patients in Zambia.
Holmes, Mody and colleagues from the University of California, San Francisco; the University of California, Berkeley; the University of Alabama; and the Centre for Infectious Disease Research in Zambia investigated whether extending appointment intervals and pharmacy pickup intervals to six months resulted in improvements in continuous patient care.
The rapid scale-up of HIV treatment in Zambia has overburdened clinics, decreasing their ability to provide individualized care to patients. This, in conjunction with the significant barriers patients face to remaining in care, including access to transportation, time away from work, clinic wait times and conflicting priorities, has limited adherence to long-term HIV treatment.
By evaluating the visit frequency patterns of patients at 63 clinics supported by the Centre for Infectious Disease Research in Zambia, the investigators found that suboptimal integration of clinical follow-up and pharmacy refills required patients to return to the clinic on a frequent basis. There were also substantial differences in appointment scheduling practices between clinics. Patients given extended clinic return intervals had improved retention in care, fewer missed visits and less gaps in medications, and fewer patients were lost to follow-up. This work suggests that clinics could decrease the number of missed visits and the number of patients taking gaps in treatment, and increase patients’ engagement in care by extending the intervals at which they could seek care.
****EMBARGOED FOR RELEASE UNTIL 2:30 P.M. P.S.T. ON FEB. 15****
Marked Mortality and Retention Underreporting in a Large HIV Program in Zambia
Presented during “Measuring the Global HIV Care Cascade” – P – W1.
Poster Number: 995
Where: Poster Hall 4 EF
When: 2:30–4 p.m.
Researcher Charles Holmes, M.D., M.P.H., associate professor of medicine at the Johns Hopkins University School of Medicine and board member for the Centre for Infectious Disease Research in Zambia, will present on the retention and outcomes of HIV patients in Zambia.
Holmes will discuss research he and his colleagues from the Centre for Infectious Disease Research in Zambia; the University of California, Berkeley; Stellenbosch University; the University of Alabama at Birmingham; and the University of California, San Francisco conducted in collaboration with the Zambian government.
Little is known about the outcomes of patients lost to follow-up in large HIV programs in sub-Saharan Africa. The investigators studied a network of 70 facilities offering HIV care in Zambia and monitored patients lost to follow-up, meaning these patients had no contact with their clinic for more than 90 days or missed an appointment in the last 180 days. Researchers found that of 54,172 patients in the sample, 11,152 were lost to follow-up. To discern how to better serve this population, a rigorous tracing effort was employed among a random sample of those lost. The study found that routine monitoring has substantially underestimated the mortality rate and rates of retention in care in this population, and there is substantial variability across sites and provinces. These inaccuracies have the potential to undermine assessments of the effectiveness of public health programs in Zambia, and adoption of this tracing methodology may assist in improving the quality of HIV programs.
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