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The Treatment Ambassador Program: A Highly Acceptable and Feasible Community-Based Peer Intervention for South Africans Living with HIV Who Delay or Discontinue Antiretroviral Therapy

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Abstract

We conducted a novel pilot randomized controlled trial of the Treatment Ambassador Program (TAP), an 8-session, peer-based, behavioral intervention for people with HIV (PWH) in South Africa not on antiretroviral therapy (ART). PWH (43 intervention, 41 controls) completed baseline, 3- and 6-month assessments. TAP was highly feasible (90% completion), with peer counselors demonstrating good intervention fidelity. Post-intervention interviews showed high acceptability of TAP and counselors, who supported autonomy, assisted with clinical navigation, and provided psychosocial support. Intention-to-treat analyses indicated increased ART initiation by 3 months in the intervention vs. control arm (12.2% [5/41] vs. 2.3% [1/43], Fisher exact p-value = 0.105; Cohen’s h = 0.41). Among those previously on ART (off for > 6 months), 33.3% initiated ART by 3 months in the intervention vs. 14.3% in the control arm (Cohen’s h = 0.45). Results suggest that TAP was highly acceptable and feasible among PWH not on ART.

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Acknowledgements

We would like to thank the individuals who participated in this study, and the broader study team. The Treatment Ambassador Program (TAP) was supported by: National Institute of Health (NIH); Institute: National Institute of Mental Health (NIMH); Type: Planning Grant (R34). Project #: 5R34MH108393-02. Dr. Bogart was additionally support by P30MH058107. Dr. Bassett was supported to this work by a K24AI141036 grant from the NIH. The study can be referenced on Clinicaltrials.gov under the unique identifier NCT03099707. We particularly wish to acknowledge our Program Officer at the National Institute of Mental Health (NIMH), Michael Stirratt, Ph.D., Program Chief at the NIMH Division of AIDS Research for scientific guidance throughout the study.

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  1. Catherine Orrell and Kathy Goggin shared senior authorships.

Authors and Affiliations

  1. Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA

    Ingrid T. Katz, Garrett M. Fitzmaurice & Sonja Steck

  2. Harvard Medical School, Boston, MA, USA

    Ingrid T. Katz, Garrett M. Fitzmaurice & Ingrid V. Bassett

  3. Massachusetts General Hospital Center for Global Health, Boston, MA, USA

    Ingrid T. Katz

  4. Harvard Global Health Institute, Cambridge, MA, USA

    Ingrid T. Katz

  5. RAND Corporation, Santa Monica, CA, USA

    Laura M. Bogart

  6. Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    Garrett M. Fitzmaurice

  7. Laboratory for Psychiatric Biostatistics, McLean Hospital, Belmont, MA, USA

    Garrett M. Fitzmaurice

  8. Health Services and Outcomes Research, Children’s Mercy Kansas City, Kansas City, MO, USA

    Vincent S. Staggs & Kathy Goggin

  9. School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA

    Vincent S. Staggs & Kathy Goggin

  10. Silver School of Social Work, New York University, New York, NY, USA

    Marya V. Gwadz

  11. Department of Medicine, Massachusetts General Hospital, Boston, MA, USA

    Ingrid V. Bassett

  12. Desmond Tutu HIV Foundation, University of Cape Town Medical School, Cape Town, South Africa

    Anna Cross, Ingrid Courtney, Regina Panda & Catherine Orrell

  13. School of Public Health, University of the Western Cape, Cape Town, South Africa

    Lungiswa Tsolekile

  14. Oregon Health & Science University-Portland State University School of Public Health, Portland, OR, USA

    David R. Bangsberg

  15. School of Pharmacy, University of Missouri-Kansas City, Kansas City, MO, USA

    Kathy Goggin

  16. Division of Women’s Health, Brigham and Women’s Hospital, 1620 Tremont St. – 3rd Floor, Boston, MA, 02120, USA

    Ingrid T. Katz

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Correspondence to Ingrid T. Katz.

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Katz, I.T., Bogart, L.M., Fitzmaurice, G.M. et al. The Treatment Ambassador Program: A Highly Acceptable and Feasible Community-Based Peer Intervention for South Africans Living with HIV Who Delay or Discontinue Antiretroviral Therapy. AIDS Behav 25, 1129–1143 (2021). https://doi.org/10.1007/s10461-020-03063-1

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