Ngcobo Sanele, Olorunju Steve, Nkwenika Tshifhiwa, Rossouw Theresa
Department of Family Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
Biostatistics Unit, South African Medical Research Council, Pretoria, South Africa.
South Afr J HIV Med. 2022 Dec 7;23(1):1446. doi: 10.4102/sajhivmed.v23i1.1446. eCollection 2022.
Only 66% of South African people living with HIV (PLWH) are virologically suppressed. Therefore, it is important to develop strategies to improve outcomes.
Assess the effect of interventions on 12-month retention in care and virological suppression in participants newly initiated on antiretroviral therapy.
Fifty-seven clinics were randomised into four arms: Ward-based primary health care outreach teams (WBPHCOTs); Game; WBPHCOT-Game in combination; and Control (standard of care). Sixteen clinics were excluded and four re-allocated because lay counsellors and operational team leaders failed to attend the required training. Seventeen clinics were excluded due to non-enrolment.
A total of 558 participants from Tshwane district were enrolled. After excluding ineligible participants, 467 participants were included in the analysis: WBPHCOTs ( = 72); Games ( = 126); WBPHCOT-Games ( = 85); and Control ( = 184). Retention in care at 12 months was evaluable in 340 participants (86.2%) were retained in care and 13.8% were lost to follow-up. The intervention groups had higher retention in care than the Control group, but this only reached statistical significance in the Games group (96.8% vs 77.8%; relative risk [RR] 1.25; 95% confidence interval [CI]: 1.13-1.38; = 0.01). The 12 month virologic suppression rate was 75.3% and was similar across the four arms.
This study demonstrated that an adherence game intervention could help keep PLWH in care.
Evidence that interventions, especially Games, could improve retention in care.
在南非，只有66%的艾滋病毒感染者（PLWH）实现了病毒学抑制。因此，制定改善治疗效果的策略很重要。
评估干预措施对新开始接受抗逆转录病毒治疗的参与者12个月护理留存率和病毒学抑制的影响。
57家诊所被随机分为四组：基于病房的初级卫生保健外展团队（WBPHCOTs）；游戏干预组；WBPHCOT与游戏干预联合组；以及对照组（标准护理组）。16家诊所被排除，4家因外展咨询员和运营团队负责人未参加所需培训而重新分配。17家诊所因未招募到足够参与者而被排除。
共招募了来自茨瓦内区的558名参与者。排除不符合条件的参与者后，467名参与者纳入分析：WBPHCOTs组（n = 72）；游戏干预组（n = 126）；WBPHCOT与游戏干预联合组（n = 85）；对照组（n = 184）。340名参与者（86.2%）的12个月护理留存情况可评估，其中86.2%的参与者持续接受护理，13.8%失访。干预组的护理留存率高于对照组，但仅游戏干预组达到统计学显著差异（96.8%对77.8%；相对风险[RR] 1.25；95%置信区间[CI]：1.13 - 1.38；P = 0.01）。12个月的病毒学抑制率为75.3%，四组相似。
本研究表明，依从性游戏干预有助于艾滋病毒感染者持续接受护理。
有证据表明干预措施，尤其是游戏干预，可提高护理留存率。
