Same treatment, different approach, better results: HIV breakthrough in KZN

HIV-positive people would benefit from being able to access services and treatment closer to home, after hours and at weekends, a new study in KwaZulu-Natal has concluded.

It found that community-based delivery of antiretroviral therapy (ART), alongside support groups in homes, increased viral suppression compared with clinic-based treatment, especially among men.

In a paper published in The Lancet, researchers from the University of Washington and the Human Sciences Research Council (HSRC) recommended that community-based ART should be implemented and evaluated, especially for people with detectable viral load.

Between 2016 and 2019, the researchers compared HIV-positive people who were not on treatment and had detectable viral load with those who were receiving their treatment at clinics.

After 12 months they noticed that about 73% who were initially not on treatment and later treated in the community had achieved increased viral suppression, compared to 54% of those treated at clinics.

The hybrid approach, where patients initially received treatment at clinics and later at community level, achieved viral suppression in 66% of people.

“Streamlined services that overcome barriers to care can increase the proportion of people living with HIV who start [treatment] and reach viral suppression,” said lead researcher Ruanne Barnabas, an infectious disease specialist from the University of Washington.

The researchers found that barriers to care included:

• standard opening hours;
• stigma;
• unfavourable perceptions of clinics and staff;
• cost of transport; and
• lost wages.

Men might experience additional barriers such as gender norms that inhibit them from seeking care. As a result, many men did not initiate treatment at conventional facilities.

Multiple clinic visits were also regarded as a turn-off by many and contributed to people dropping out of treatment within the first 12 months.

“Offering convenient locations and times after hours and on weekends, being flexible to meet travel or mobility needs, offering quarterly refills, and streamlining monitoring and resupply had better viral suppression outcomes, especially for men,” the researchers said.

“However, questions remain regarding how community-based ART could be implemented at scale in the absence of established delivery platforms and systems.”

They suggested that refining components of the community strategy could contain costs. For example, providing a six-month supply of antiretrovirals instead of a three-month resupply could save personnel costs.

TimesLIVE