Original Research

Group counselling for adherence support among young people failing first-line antiretroviral therapy in Zimbabwe

Bahati Kasimonje, Tinei Shamu, Tinahe Mudzviti, Ruedi Luethy
Southern African Journal of HIV Medicine | Vol 22, No 1 | a1292 | DOI: https://doi.org/10.4102/sajhivmed.v22i1.1292 | © 2021 Bahati Kasimonje | This work is licensed under CC Attribution 4.0
Submitted: 05 August 2021 | Published: 29 October 2021

About the author(s)

Bahati Kasimonje, Newlands Clinic, Harare, Zimbabwe
Tinei Shamu, Newlands Clinic, Harare, Zimbabwe; and, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; and, Graduate School of Health Sciences, University of Bern, Bern, Switzerland
Tinahe Mudzviti, Newlands Clinic, Harare, Zimbabwe; and, Department of Pharmacy and Pharmaceutical Sciences, University of Zimbabwe, Harare, Zimbabwe
Ruedi Luethy, Newlands Clinic, Harare, Zimbabwe


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Abstract

Background: Sub-optimal adherence to antiretroviral therapy (ART) is reportedly worse amongst young people living with HIV (YPLHIV). Group adherence counselling can be useful to improve adherence.

Objectives: We evaluated an enhanced adherence counselling group intervention (EACGI) amongst YPLHIV failing a non-nucleoside reverse transcriptase (NNRTI)-based first-line ART regimen.

Method: This was a retrospective cohort study using routinely collected data of YPLHIV failing NNRTI-based first-line ART. Patients with confirmed virological failure were referred for EACGI, a 12-week curriculum of weekly, 1.5-h sessions accommodating 8–15 people per group. It aimed to facilitate readiness to switch to second-line ART and improve adherence through a mental health intervention. Viral loads of HIV were measured pre-EACGI; at baseline; 3, 6 and 12 months post switch.

Results: Fifty-seven patients aged 13–25 years were invited to EACGI and followed for up to 48 weeks. Thirty-three (58%) patients attended at least four sessions, whilst 24 (42%) attended none. Amongst those who attended none, two (8%) were transferred out, three (13%) were lost to follow-up and two (8%) had died by week 48 of follow-up, whilst all who attended were still in care. By week 48, amongst patients still in care, 29%, 44% and 67% of those who attended no sessions, 4–9 and 10–12 sessions, respectively, had viral loads of < 50 copies/mL.

Conclusion: An EACGI is a promising intervention for YPLHIV failing ART prior to treatment switch, leading to improved adherence. This study’s findings support the need for further enquiry into rigorous, evidence-based multilevel adherence interventions that are acceptable and effective for YPLHIV.


Keywords

enhanced adherence counselling; adolescents; mental health; antiretroviral therapy; virological failure

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