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Improving Clinic Attendance and Adherence to Antiretroviral Therapy Through a Treatment Supporter Intervention in Uganda: A Randomized Controlled Trial

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Abstract

We assessed the effectiveness of the treatment supporter initiative as an intervention in improving clinic attendance for antiretroviral (ARV) drug refills and adherence to antiretroviral therapy (ART) in a cohort of HIV-infected adults. This two-arm randomized controlled trial was undertaken at an HIV clinic in a district hospital in Uganda. A total of 174 adult patients on ART were randomized 1:1 to a standard adherence intervention package plus a treatment supporter intervention (TS arm) or to a standard adherence intervention package (non-TS arm) alone. Clinic attendance for refills and adherence measurements using monthly clinic-based pill counts were monitored for both arms for 28 weeks. Baseline characteristics were similar for both arms. There was a non-significant difference in mean adherence between the TS and non-TS groups at end of follow-up [99.1% (95% CI: 98.3–99.9% vs. 96.3% (95% CI: 94.2–98.3%), P > 0.05]. TS participants had more than four times the odds of achieving optimal adherence (≥95%) [Odds ratio (OR) = 4.51, 95% CI: 1.22–16.62, exact P = 0.027]. TS participants were also more likely to be on time for their clinic appointments: 91.6 vs. 90.1% for TS and non-TS, respectively (OR = 1.19, 95% CI: 0.74–1.91, P > 0.05). Use of patient-selected treatment supporters may be an effective intervention to improve ARV treatment outcomes in resource-constrained settings.

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Acknowledgments

We acknowledge the support of the Ugandan National AIDS Control Programme in facilitating this study. We thank the management and health workers of the Jinja Hospital. The study team also acknowledges the invaluable contributions of the adherence workers namely, Josephine Mirembe, Isaac Buzaka, Loyce Babirye, and Richard Olwa. The authors also wish to thank the partnership involving the United States Agency for International Development (USAID), Joint Clinical Research Centre (JCRC), and Uganda Health Communication Partnership for making available their adherence diaries to the study participants. Special thanks to all ART clients and members of the community including the treatment supporters who willingly participated in the study. Without their input, this study would not have been possible. The project was funded by the Communicable Disease Research Programme (COMDIS) Consortium led by the Nuffield Centre at Leeds University which itself is funded by the Department for International Development, United Kingdom.

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Authors and Affiliations

  1. Nuffield Centre for International Health and Development, Institute of Health Sciences, Leeds University, Leeds, UK

    Setor Kunutsor & John Walley

  2. Communicable Disease Research Programme Consortium, Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda

    Elly Katabira & Simon Muchuro

  3. Uganda National AIDS Control Programme, Kampala, Uganda

    Hudson Balidawa, Elizabeth Namagala & Eric Ikoona

  4. Malaria Consortium, COMDIS MUK, P.O. Box 8045, Kampala, Uganda

    Setor Kunutsor

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  1. Setor Kunutsor
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Correspondence to Setor Kunutsor.

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Kunutsor, S., Walley, J., Katabira, E. et al. Improving Clinic Attendance and Adherence to Antiretroviral Therapy Through a Treatment Supporter Intervention in Uganda: A Randomized Controlled Trial. AIDS Behav 15, 1795–1802 (2011). https://doi.org/10.1007/s10461-011-9927-9

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