You, William Xiaotong
School of Public Health - International Health
South Africa-An Adaptive Randomized Evaluation of Nurse-Led HIV Treatment Retention Interventions for Women Living with HIV
The overarching goal of the study is to test the effectiveness of an adaptive and patient-responsive strategy of HIV treatment and individualized case management to achieve sustained HIV viral suppression among marginalized women living with HIV in Durban, South Africa. Our data from South Africa consistently indicate over 60% HIV prevalence among Female Sex Workers (FSW), with adverse clinical outcomes and high risk of onward HIV transmission given limited uptake of treatment. The determinants of limited coverage of treatment among these FSW are multifactorial, including barriers to the effective delivery and uptake of HIV treatment among those living with HIV. Thus, we need multicomponent interventions that address these multilevel gaps in order to optimize treatment. However, not all FSW will benefit from or need the same intervention or intensity to achieve HIV viral suppression.
The interventions being tested in this adaptive study include mobile decentralized treatment programs (DTP) and individualized case management (ICM). These approaches have not been formally tested within a marginalized population such as FSW, nor have the incremental benefits and cost-effectiveness of these interventions been evaluated. Furthermore, mobile van-based nurse-led treatment initiation and ART management represent a novel type of decentralized care in South Africa. In addition, there are limited data describing the characteristics of those that require more intensive interventions. Using a novel study design that re-randomizes indivduals during the trial based on their responsiveness to their originally assigned intervention, the study results will help to inform selective scale up of services for FSW and assess benefits for those that have not been successful in achieving sustained viral suppression and learn how to target the intensity of future ART packages for FSW.
PI Mentor: Sheree Schwartz