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Community-based Adherence Clubs improve outcomes for stable ART patients: Outcomes from Cape Town, South Africa Anna Grimsrud 1, Maia Lesosky 1,2, Cathy.

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Presentation on theme: "Community-based Adherence Clubs improve outcomes for stable ART patients: Outcomes from Cape Town, South Africa Anna Grimsrud 1, Maia Lesosky 1,2, Cathy."— Presentation transcript:

1 Community-based Adherence Clubs improve outcomes for stable ART patients: Outcomes from Cape Town, South Africa Anna Grimsrud 1, Maia Lesosky 1,2, Cathy Kalombo 3, Linda-Gail Bekker 2,4, Landon Myer 1 1 Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town 2 Department of Medicine, University of Cape Town 3 Provincial Government of the Western Cape, Cape Town 4 Desmond Tutu HIV Foundation, Cape Town IAS 2015, Vancouver July 22 nd 2015

2 Background Gugulethu ART cohort Innovative models of care “Adherence Club” model of ART delivery

3 Gugulethu ART cohort

4 Model of ART delivery Hospital-based, doctor-led, with frequent visitsCommunity health centre, nurse-led, CHW supported, less frequent clinical consultations

5 Introduce Adherence Clubs Background An Adherence Club: CHW-led, nurse- supported ~30 stable patients Meets 5 times/year Receives pre-packed ART

6 Introduce Adherence Clubs Background Stable patients - On ART > 6-12-months Suppressed viral load No condition requiring frequent clinical consultation

7 Community-based Adherence Clubs (CACs) All visits are outside of the health facility Emphasis on peer-based support and patient self- management ART can be collected by a treatment “buddy”

8 Methods Community adherence club (CAC) patients enrolled from June 2012-December 2013 Describe profile of Club patients and their outcomes LTFU (no visit in the first 12 weeks of 2014) Viral rebound (VL>1000 copies/ml after suppression) Time to outcomes analysed by gender and age Outcome of CAC patients using proportional hazards models Adjusted for demographic, programmatic and clinical variables (time-updated viral load and CD4)

9 Methods (2) Compare outcomes to standard of care (SoC) patients Proportional hazards models with CAC participation as a time- varying covariate Modelled the probability of CAC participation using inverse probability weighting Restricted to patients for whom CACs with available Further sensitivity analysis with greater restriction, not incorporating the IPW, logistic regression model and propensity scores. Stratified hazard ratios by sub-group

10 Results - 2000+ patients in 74 CACs Pre-ART characteristicCommunity-based Adherence Club n=2 113 Gender Females, n(%)1 489 (70.5) Age (years), n(%) 16-24156 (7.4) 25-341 026 (48.6) 35-44656 (31.1) ≥45275 (13.0) Median (IQR)33.9 (29.4-39.8) CD4 cell count (cells/μl), n(%) <50275 (16.2) 50-99336 (19.8) 100-199688 (40.6) ≥200397 (23.4) Median (IQR)134 (73-195)

11 Results – Description of CAC patients (2) Patient characteristicsCommunity-based Adherence Club n=2 113 Year of ART initiation, n(%)2002-2004191 (9.0) 2005-2007758 (35.9) 2008-2010803 (38.0) 2011-2012361 (17.1) Every sent a “buddy”, n(%)Yes573 (27.1) Time on ART before CAC, Median (IQR)4.4 (2.5-6.6) 2002-20048.6 (8.2-9.2) 2005-20076.4 (5.7-7.1) 2008-20103.3 (2.6-4.0) 2011-20121.4 (1.2-1.7)

12 Results LTFU – 94% retained at 12-months Viral rebound – 98% suppressed at 12-months In final models of LTFU & viral rebound No difference by gender or in those who sent a “buddy” Increased risk in patients 16-24 years at ART initiation

13 CACs associated with reduced risk of LTFU in all approaches compared to SoC 67% reduction in the risk of LTFU compared to the standard of care

14 In summary Key Findings CACs may achieve favourable programmatic outcomes for stable patients in resource-limited settings CAC participation was associated with a substantial decrease in the risk of LTFU compared to facility-based care Limitations Limited follow-up time at a single site Selection bias into the intervention Residual confounding

15 Patient populations End points Model components and flexibilities Policy and regulations Model expansion Research agenda going forward

16 Let’s define the conversation Task shifting Decentralization Demedicalization of HIV Community-based services Increased patient self- management Simplified ART delivery MODELS OF CARE

17

18 For more information agrimsrud@gmail.com At IAS 2015- Wilkinson L et al. "Implementation scale up of the Adherence Club model of care to 30,000 stable antiretroviral therapy patients in the Cape Metro: 2011-2014”. Abstract #MOAD0105LB. Grimsrud A et al. “Implementation of community-based adherence clubs for stable antiretroviral therapy patients”. Abstract #TUPED791 Adherence Club toolkit - https://www.msf.org.za/msf-publications/how-to-keep-art-patients-long- term-care-art-adherence-club-report-and-toolkit

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