A small cluster randomised clinical trial to improve health outcomes among Argentine patients disengaged from HIV care

dc.contributor.authorSued, Omar
dc.contributor.authorCecchini, Diego
dc.contributor.authorRolón, María José
dc.contributor.authorCalanni, Liliana
dc.contributor.authorDavid, Daniel
dc.contributor.authorLupo, Sergio
dc.contributor.authorCahn, Pedro
dc.contributor.authorCassetti, Isabel
dc.contributor.authorWeiss, Stephen M.
dc.contributor.authorAlcaide, Maria Luisa
dc.contributor.authorRodriguez, Violeta J.
dc.contributor.authorMantero, Alejandro
dc.contributor.authorJones, Deborah L.
dc.date.accessioned2024-05-20T19:15:29Z
dc.date.available2024-05-20T19:15:29Z
dc.date.issued2022-06
dc.description.abstractBackground Patients disengaged from HIV care, e.g., missed medication pick-ups, not attending physician visits, account for ≥70% of new HIV infections. Re-engaging and sustaining engagement is essential to controlling the HIV pandemic. This study tested a physician-delivered evidence-based intervention, Motivational Interviewing (MI), to improve health outcomes, adherence to antiretroviral therapy (ART), HIV virologic suppression, CD4+ count, retention in HIV care, and self-efficacy among patients disengaged from care in Argentina. Methods Regional clinics (n = 6) were randomised to condition, MI Intervention or Enhanced Standard of Care (ESOC), and recruited N = 360 patients disengaged from HIV care. ART adherence, HIV RNA viral load, CD4+ count retention, and self-efficacy were assessed at baseline, 6, 12, 18, and 24-months. Indirect effects from condition to main outcomes were examined using patient–provider relationship as a mediator. The study was a cluster-randomised clinical trial entitled Conexiones y Opciones Positivas en la Argentina 2 (COPA2) and was registered at clinicaltrials.gov, NCT02846350. Findings Participants were an average age of 39·15 (SD = 10·96), 51% were women; intervention participants were older (p = ·019), and more ESOC participants were women (60% vs. 42%, p = 0·001). Using mixed models, the intervention had no effect on ART adherence over time by condition on HIV RNA viral load, CD4+ count retention, or self-efficacy. However, analysing mediated paths, there was an indirect effect of condition on ART adherence (B = 0·188, p = 0·009), HIV viral load (B = -0·095, p = 0·027), and self-efficacy (B = 0·063, p = 0·001), suggesting the intervention was associated with improved patient–provider relationships, which was in turn associated with increased ART adherence, lower HIV viral load, and higher self-efficacy. Interpretation These findings suggest that physician-delivered MI may enhance the patient-provider relationship, self-efficacy, and ART adherence, and reduced HIV viral load in patients disengaged from HIV care. However, these findings are preliminary due to the small number of clusters randomised, and replication is warranted.
dc.identifier.citationThe Lancet Regional Health - Americas 2022;13: 100307
dc.identifier.otherhttps://doi.org/10.1016/j.lana.2022.100307
dc.identifier.urihttps://repositorio.huesped.org.ar/handle/123456789/979
dc.language.isoen
dc.relation.ispartofseriesThe Lancet Regional Health - Americas; 13: 100307
dc.subjectHIV
dc.subjectClinical trial
dc.subjectGlobal health
dc.titleA small cluster randomised clinical trial to improve health outcomes among Argentine patients disengaged from HIV care
dc.typeArticle

Files

Original bundle
Now showing 1 - 1 of 1
Loading...
Thumbnail Image
Name:
20_2022_Sued_A small cluster randomised clinical trial to improve health outcomes among Argentine patients disengaged from HIV care.pdf
Size:
1.62 MB
Format:
Adobe Portable Document Format
License bundle
Now showing 1 - 1 of 1
No Thumbnail Available
Name:
license.txt
Size:
1.71 KB
Format:
Item-specific license agreed to upon submission
Description: