Journal or Book Title
Journal of Acquired Immune Deficiency Syndrome
HIV differentiated service delivery (DSD) models are scaling up in resource-limited settings for stable patients; less is known about DSD outcomes for patients with viremia. We evaluated the effect on viral suppression (VS) of a streamlined care DSD model implemented in the SEARCH randomized universal test and treat trial in rural Uganda and Kenya (NCT:01864603).
We included HIV-infected adults at baseline (2013) who were country guideline antiretroviral therapy (ART) eligible (prior ART experience or CD4 ≤ 350) with ≥1 HIV clinic visit between 2013 and 2017 in SEARCH communities randomized to intervention (N = 16) or control (N = 16). We assessed the effect of streamlined care in intervention community clinics (patient-centered care, increased appointment spacing, improved clinic access, reminders, and tracking) on VS at 3 years. Analysis was stratified by the baseline care status: ART-experienced with viremia, ART-naïve with CD4 ≤ 350, or ART-experienced with VS.
Among 6190 ART-eligible persons in care, year 3 VS was 90% in intervention and 87% in control arms (RR 1.03, 95% CI: 1.01 to 1.06). Among ART-experienced persons with baseline viremia, streamlined care was associated with higher VS (67% vs 47%, RR 1.41, 95% CI: 1.05 to 1.91). Among ART-naïve persons, VS was not significantly higher with streamlined care (83% vs 79%, RR 1.05, 95% CI: 0.95 to 1.16). Among ART-experienced persons with baseline VS, nearly all remained virally suppressed in both arms (97% vs 95%, RR 1.01, 95% CI: 1.00 to 1.03).
Streamlined care was associated with higher viral suppression among ART-experienced patients with viremia in this randomized evaluation of ART-eligible patients who were in care after universal HIV testing.
UMass Amherst Open Access Policy
Hickey, Matthew D.; Ayieko, James; Kwarisiima, Dalsone; Opel, Fredrick J.; Owaraganise, Asiphas; Balzer, Laura B.; Chamie, Gabriel; Jain, Vivek; Peng, James; Camlin, Carol; Charlebois, Edwin D.; Cohen, Craig R.; Bukusi, Elizabeth A.; Kamya, Moses R.; Petersen, Maya L.; and Havlir, Diane V., "Improved Viral Suppression With Streamlined Care in the SEARCH Study" (2020). Biostatistics and Epidemiology Faculty Publications Series.
85(5), 571-578 https://doi.org/10.1097/QAI.0000000000002508