SEATTLE – Providing immune cell testing and HIV treatment counseling immediately after a positive HIV test was the first in a series of measures that increased rapid linkage to care and retention at ten clinic sites in Mozambique, data presented here Thursday showed.
Measures in a randomized trial of interventions in Maputo and Inhambane Province also included accelerated access to antiretroviral treatment and text message appointment reminders. Findings from the trial were presented by Matthew Lamb from ICAP at Columbia University.
The findings offered a comparison of outcomes for patients who were offered these additional interventions and patients who were offered the standard of care. A subset of the 2,000 patients followed in the trial received an additional financial incentive of a $5 phone card that was offered when the patient presented for care, and at 6 month and 12 month visits. The financial incentive, it turned out did not make a difference in patient linkage or retention.
Seventy-three percent of the patients receiving the combination intervention were linked to care within one month of diagnosis and remained in care a year later, compared to 47 percent of the patients in the standard of care group. The combination intervention increased quick linkage to care and retention by 50 to 60 percent but Lamb noted that additional interventions were needed to maximize individual and public health benefits of HIV treatment.
In the same session, Wayne Steward from University of California, San Francisco reported on two interventions aiming to improve patient retention tested in the I-CARE Trial in North West Province, South Africa. That trial compared the impact of text messages, and the use of peer navigators to the standard of care in 18 primary care clinics. The study included 752 patients who had been diagnosed with HIV within the previous 12 months who were randomized to receive text messages, text messages and the active support of peer navigators who were also living with HIV, or the standard of care. The text messages included appointment reminders, two-way text queries about how patients were faring (with providers following up on issues raised), and health promotion messages to encourage HIV prevention behaviors, medication adherence and healthy behaviors including reduced alcohol use. Trained peer navigators were paid a modest stipend to meet with study participants at least once a month and to stay in touch at least biweekly through phone or text.
Participants who received both text messages and peer navigation services were three times more likely to stay in care than those who received only text messages or the standard of care. More intensive peer navigation services translated into even better retention. Text messaging alone did not improve retention compared to the standard of care. Members of the study team, Steward said, hope to develop peer navigation models for men who have sex with men and transgender populations.