VITAL Start: Video-Based Intervention to Inspire Treatment Adherence for Life—Pilot of a Novel Video-Based Approach to HIV Counseling for Pregnant Women Living with HIV

  • Maria H. KimEmail author
  • Saeed Ahmed
  • Tapiwa Tembo
  • Rachael Sabelli
  • Robert Flick
  • Xiaoying Yu
  • Alick Mazenga
  • Holly Le Blond
  • Katie Simon
  • Miriam Hartig
  • Elizabeth Wetzel
  • Rose Nyirenda
  • Peter N. Kazembe
  • Mtisunge Mphande
  • Angella Mkandawire
  • Mike J. Chitani
  • Elaine J. Abrams
Original Paper


We developed and piloted a video-based intervention targeting HIV-positive pregnant women to optimize antiretroviral therapy (ART) retention and adherence by providing a VITAL Start (Video-intervention to Inspire Treatment Adherence for Life) before ART. VITAL Start (VS) was grounded in behavior-determinant models and developed through an iterative multi-stakeholder process. Of 306 pregnant women eligible for ART, 160 were randomized to standard of care (SOC), 146 to VS and followed for one-month. Of those assigned to VS, 100% completed video-viewing; 96.5% reported they would recommend VS. Of 11 health workers interviewed, 82% preferred VS over SOC; 91% found VS more time-efficient. Compared to SOC, VS group had greater change in HIV/ART knowledge (p < 0.01), trend towards being more likely to start ART (p = 0.07), and better self-reported adherence (p = 0.02). There were no significant group differences in 1-month retention and pharmacy pill count. VITAL Start was highly acceptable, feasible, with promising benefits to ART adherence.


HIV ART Adherence Retention Video Counseling Malawi 



We thank the Ministry of Health for their partnership in this endeavor. We are very grateful to the women living with HIV, families, community members, and HCWs who participated in the development and piloting of the VS intervention. We appreciate the support provided by all VITAL Start team members.


The contents of this report are the sole responsibility of the authors and do not necessarily reflect the views of the National Institute for Health or the United States Government.


Support for this study was made possible by the Fogarty International Center of the National Institutes of Health under Award Number K01 TW009644 as well the National Institute of Mental Health R01MH115793.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Maria H. Kim
    • 1
    • 2
    Email author
  • Saeed Ahmed
    • 1
    • 2
  • Tapiwa Tembo
    • 2
  • Rachael Sabelli
    • 2
  • Robert Flick
    • 1
    • 2
  • Xiaoying Yu
    • 3
  • Alick Mazenga
    • 2
  • Holly Le Blond
    • 4
  • Katie Simon
    • 1
    • 2
  • Miriam Hartig
    • 1
    • 2
  • Elizabeth Wetzel
    • 1
    • 2
  • Rose Nyirenda
    • 5
  • Peter N. Kazembe
    • 1
    • 2
  • Mtisunge Mphande
    • 2
  • Angella Mkandawire
    • 2
  • Mike J. Chitani
    • 2
  • Elaine J. Abrams
    • 6
  1. 1.Baylor College of Medicine International Paediatric AIDS InitiativeTexas Children’s HospitalHoustonUSA
  2. 2.Baylor College of Medicine - Abbott Fund Children’s Clinical Centre of ExcellenceLilongwe 3Malawi
  3. 3.University of Texas Medical Branch at GalvestonGalvestonUSA
  4. 4.In Tune for LifeLondonUK
  5. 5.HIV UnitMalawi Ministry of HealthLilongweMalawi
  6. 6.ICAP at Columbia, Mailman School of Public Health and Vagelos College of Physicians & SurgeonsColumbia UniversityNew YorkUSA

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