MASIVUKENI: A Multimedia ART Initiation and Adherence Intervention for Resource-Limited Settings Robert H. Remien, Claude A. Mellins, Reuben Robbins, Hetta Gouse, Cheng-Shiun Leu, Jessica Rowe, Michelle Henry, Landon Myer, Nadia Nguyen, Dan Stein, and John Joska Masivukeni  This NIMH-funded study enrolled HIV+ adults initiating ART at one of 2 township clinics in Cape Town (N=455).  Participants were randomized to Masivukeni or Standard of Care, at a 2:1 ratio, and followed for 12 months.  Masivukeni is a laptop-based, multimedia ART adherence intervention (Social Action Theory)  3-4 sessions delivered prior to/during ART initiation  Follow-up sessions for defaulters  Treatment support with “buddies” ART adherence and growing role of lay counselors  Growing number of people initiating ART in South Africa and globally, but ART adherence and retention problems are an ongoing concern.  In resource-constrained settings, increasing reliance on lay counselors to provide ART adherence counseling.  Need for standardized and effective ART adherence interventions that can be scaled-up and delivered by lay counselors.

The Multimedia Intervention

Study Aim: Examine the impact of Masivukeni on viral suppression and ART initiation among HIV+ patients. Viral suppression: Medical record viral load results ≤ 400 at 12 months post ART initiation. ART initiation: Medical record indication of ART initiation by 12-months Statistical analysis  Chi-square (Fisher’s Exact Test); results presented overall and by gender  Among Masivukeni participants, we also examined participation of “buddies” in the intervention Methods and Sample Table 1. Baseline characteristics Predominantly Black, Xhosa- speaking Female74% Age (mean) 33 years Socioeconomic status Graduated from high school 29% Currently working42% Income ≤R1500 per month43% Health status Currently infected with TB22% CD4 count <20040% % >35016% * Baseline characteristics did not different significantly by intervention arm

Results and Conclusions  The Masivukeni intervention was highly acceptable to counselors and patients in busy SA clinics (Gouse et al., WEPEE569; Rowe et al., THPEE536).  74% of the sample had viral loads in medical charts at 12 months, with very high viral suppression rates (95%), and no difference between study arms.  There was a trend in the Masivukeni arm for improved viral suppression when there was >50% participation by “buddy” (98% vs. 91%, p=0.1).  Women in the Masivukeni intervention were more likely to initiate ART than women in the SOC (p=.02); this effect was not found for men. Masivukeni SOC N%N%p-value Among women Initiated ART Did not initiate ART Among men Initiated ART Did not initiate ART Next Steps:  Account for LTF and missing viral load data  Collect 24-month viral load data  Compare clinical outcomes for study participants to general patient populations Limitations:  Ceiling effect (high viral suppression)  Small # of men  Incomplete data (to date) Thank you to the participants, the Masivukeni team, and NIMH funding: R01-MH9557 (M. Stirratt, Ph.D.); and P30- MH43520 (C. Gordon, Ph.D.)