Project Title

Improving RETention and viral load outcomes for people taking Antiretroviral therapy through early IdentificatioN of missed doses.

Project Objectives

Explore whether a medication adherence app can improve ART retention and adherence in newly diagnosed adolescents living with HIV in Benue state, Nigeria

Host Organisation

EDCTP Project Call

Senior Fellowship Plus (SFP)

Study Design

Interventional

Project Summary

Too few South Africans living with HIV achieve viral suppression. Although advances in antiretroviral therapy (ART) have reduced illness and death for people with HIV (PWH), ongoing evidence highlights gaps in the HIV continuum, including poor tablet taking / adherence and low retention in care, particularly early after ART is started in resource-poor, high-burden African settings. Those who miss doses are often later lost to care. We need to address two critical priorities: first, PWH at risk of treatment failure must be identified more rapidly than current systems allow, before they leave care or develop drug resistance; second, these patients need support to keep them in care at optimal adherence levels. Through this grant we address both problems by the synergy of two projects: a highly efficient, locally informed randomised study for which the Senior Fellow was funded through an NIH R01 mechanism, called SUSTAIN, together with this EDCTP-funded project (RETAIN). Both are being conducted at three clinics in two resource-poor communities in Cape Town, South Africa (Gugulethu and Philippi). The parent SUSTAIN study evaluates two improved, but feasible, methods of flagging and contacting those people with poor adherence earlier than the current standard of care (raised viral load); namely 1. missed clinical visits / medication pick-ups, and 2. real-time electronic monitoring of adherence with the Wisepill RT2000 device (www.wisepill.com). Standard of care (SOC) would flag poor adherence based on a raised viral load (VL) twice in the first year; missed clinic visits or medication pickup gives the opportunity to flag poor adherence up to 8 times in the first year; and missing doses noted by the Wisepill device can flag poor adherence every week of the first year on ART. The RETAIN study adds an intensive therapeutic monitoring component to all those flagged with adherence lapses to clearly describe the viral load status and drug concentrations in those struggling to adhere, and to show the immediate benefit of the adherence intervention. Both studies will contribute to the implementation of an enhanced version of the packaged adherence intervention already in place in antiretroviral clinics. The study team aims to review the impact of this earlier flagging and adherence intervention both on immediate adherence behaviour and drug concentrations (short and long half-life moieties) (RETAIN); as well as on the longer-term outcome of viral suppression at 12 months (RETAIN) and 24 months (SUSTAIN). In addition, through the mentorship component of this Fellowship, a Nigerian Trainee Fellow has designed a pilot study to explore whether a medication adherence app (Lu Dedoo) can improve ART retention and adherence in newly diagnosed adolescents living with HIV in Benue state, Nigeria. Both projects support health and well-being for all at all ages, compatible with SDG3. In the first three years of the grant, both studies received appropriate local approvals and have completed recruitment. RETAIN has recruited 100% (180/180) of participants to date, and all have completed the study. Lu Dedoo has completed the qualitative component and enrolled all 60 young people to the randomised study. RETAIN data is being cleaned for final analysis. An abstract will be prepared for the 13th IAS Conference on HIV science in Kigali in 2025. We anticipate that a primary manuscript will be complete at a similar time. Through the collaboration and teamwork engendered by this Fellowship, the careers of four African researchers are being promoted and enhanced: the Senior Fellow and the Trainee Fellow (ongoing from 2021-2025), a PhD student (2023-2025) and a Masters student, due to graduate this year, thus increasing research capacity in Africa. Both PhD and MSc students have presented related abstracts and posters at local and international conferences.

Current Organisation

APIN Public Health Initiatives

Current Job Title

Deputy Project Director

Biography