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HIV Adherence Clubs Help People Stay in Care

July 23, 2015

Anna Grimsrud, Ph.D., M.P.H.

Anna Grimsrud, Ph.D., M.P.H.

BETA is attending and reporting from the 2015 International AIDS Society Conference on HIV Pathogenesis, Treatment & Prevention this week in Vancouver—bringing you the latest news, updates, and research on HIV treatment and prevention.

An oral abstract presented yesterday at the International AIDS Society Conference gave the HIV community evidence of new model of care that produced excellent HIV retention, adherence and viral suppression. Implementation of community-based "adherence clubs" in the Gugulethu neighborhood of Cape Town, South Africa, helped 94% of approximately 2,000 people with HIV in the study to be retained in care, and 98% be virally suppressed after a year.

The adherence club model was an extension of a shift in HIV care that's been happening in the region—from frequent hospital-based, physician-led ART delivery visits to nurse-delivered care that happens less frequently, outside of hospital settings.

"The emphasis is very much based on peer support and patient self-management," said Anna Grimsrud, PhD, MPH, from the University of Cape Town, South Africa.


Each adherence club, which includes approximately 30 people with HIV, was facilitated by a community health worker at a community center. The group met five times a year for usually an hour or less, and included a group counseling session and opportunity for participants to pick up pre-packaged ART.

"Our patients meet entirely outside of the health facility at a community center, so they don't have to go to the clinic unless they're really ill or they want to go. And there's flexibility in the model, such that you can send a 'buddy' if you want to every other visit to collect your ART if you're unavailable. So this further reduces the frequency with which you have to come for your treatment from five times per year down to three at a minimum," explained Grimsrud.

The study enrolled over 2,000 people into 74 adherence clubs, and compared this group to a similar group of people who received standard-of-care treatment. Participants enrolled in the study had to be "stable": on ART for more than six months, virally suppressed, and without any medical conditions requiring in-clinic monitoring.

After a year in the adherence club care, 94% were still retained in care. (The researchers defined this as not missing a visit in the first 12 weeks of 2014.) Grimsrud said that this represents a 67% reduction in risk of lost-to-follow up compared to the standard of care treatment. After a year, 98% of people participating in the adherence club model of care remained virally suppressed.

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