HIV
Conditions
Keywords
HIV, PMTCT
Brief summary
The purpose of this study is to evaluate the comparative effectiveness of a congregation, clinic and integrated case management-based intervention for sustainable testing and retention on linkage to care, engagement, retention and viral load suppression of women and children infected with HIV.
Detailed description
Using a two-arm cluster randomized design, our proposed study will evaluate the comparative effectiveness of iSTAR, a community-based social network intervention that combines trained church-based Health Advisors and clinic-based staff and uses motivational interview skills and clinic- quality improvement approaches (Intervention Group; IG) versus a clinic-based approach (Control group; CG) on linkage, engagement, retention and viral suppression among HIV-infected women and children. Eighteen health facilities in identified local government areas in Benue state, north-central Nigeria will be randomly assigned to either the IG (N=9 health facilities) or the CG (N=9 health facilities). A total of 10,000 pregnant women will be screened and 400 HIV-infected participants will be enrolled over a 24-month period. The primary outcome will be the difference in the rate of linkage and engagement between the groups. The secondary outcome will be the difference in rate of retention and viral suppression among participants. Additionally, we will conduct network, mediation/moderation analysis to examine the roles of intermediate variables such as health team cohesion, turnovers, attitudes, leadership and dynamic adaptation on iSTAR implementation and sustainment.
Interventions
OTHERiSTAR
Each component of the iSTAR intervention targets a specific point along the HIV continuum: confidential, onsite integrated laboratory tests during baby showers targets HIV diagnosis (b) church-based Health Advisors (CHAs) trained in motivational interviewing and quality improvement skills as promotoras target linkage, engagement and adherence by providing counseling and other support to HIV-infected women and children (c) integrated network of community and clinic case management targets reduction in loss to follow-up. CHAs will support participants during the study period by being available to accompany them to clinic visits, review laboratory results and medications after clinic visits. They will be available to speak with them at intervals to see how they are doing either by phone or through home visits as they prefer. At each follow-up study visit, the trained CHA will review and collect data on participants' clinic visits, treatment, and laboratory results.
Sponsors
Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
University of Nevada, Las Vegas
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Masking
NONE
Eligibility
Sex/Gender
FEMALE
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* HIV-infected pregnant women identified during baby showers programs at participating worship centers.
Exclusion criteria
* HIV-infected women already on treatment
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Linkage in care | 1 month | Linkage in care is defined as the percentage of participants with at least one HIV medical care visit following HIV diagnosis. |
| Retention in care | 12 months | Retention is defined as the percentages of participants with two or more documented viral load measurement during the 12 months following enrollment. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| ART Initiation | 1 month | The secondary outcome is engagement in care defined as the percentage of participants initiated on ART at 1 month following enrollment. |
| Viral Suppression | 12 months | Viral suppression is defined as the percentage of participants whose most recent two viral load are \<20 copies/mL. |
Countries
Nigeria
Contacts
Primary ContactEchezona Ezeanolue, MD, MPH
Backup ContactChima Onoka, MD, PhD
Outcome results
None listed