Psychosocial factors have been linked with loss to follow-up (LTFU) and clinical outcomes among people living with HIV (PLH), however little is known about the effect of psychosocial support on LTFU among PLH in treatment and care. The purpose of this study was to explore the effect of NAMWEZA (“Yes, together we can”) friends’ psychosocial support intervention on clinical outcomes and LTFU among PLH. NAMWEZA is based on a novel program using “appreciative inquiry”, positive psychology approaches to empower, promote positive attitudes and foster hope.
PLH participating in the NAMWEZA intervention in HIV care clinics in Dar es Salaam Tanzania were compared with non-exposed PLH obtained from facilities that routinely collect clinical information and both followed longitudinally for 24 months. Baseline sociodemographic, clinical measures (CD4 cell count, hemoglobin (HGB), weight), and LTFU measures were collected. Chi square, Fisher’s exact tests, and t-tests were used to compare the frequencies for categorical variables and the means of continuous variables from the intervention and the comparison groups to identify variables that were significantly different across the two groups. Random effects models were performed to examine the bivariate associations between the intervention status and clinical outcomes.
At the end of 24 months of follow-up mean CD4 count and HGB levels increased significantly in both intervention and comparison groups (p = 0.009 and p < 0.0001, respectively). Weight increased significantly only in the intervention group (p = 0.003). Cumulative LTFU was three times higher in the comparison compared to the intervention (p < 0.001) group. Having a low CD4 count, extremes of weight, low HGB, younger age, and male gender were significantly associated with LTFU among the unexposed group, while being on ART for duration of 12 months or more was protective against LTFU in those intervened.
Among PLH on ART, exposed or not exposed to NAMWEZA intervention, clinical care outcomes improved over time. LTFU was much higher in the comparison group with factors commonly known to predict LTFU only apparent in the comparison group. NAMWEZA could be a promising peer-facilitated model to reduce LTFU among PLH in care that can be integrated in ART services; however, more research is needed to evaluate its longer term effects.
Dalal RP, Macphail C, Mqhayi M, Wing J, Feldman C, Chersich MF, et al. Characteristics and outcomes of adult patients lost to follow-up at an antiretroviral treatment clinic in Johannesburg, South Africa. J Acquir Immune Defic Syndr. 2008;47(1):101–7. PubMed
Makunde WH, Francis F, Mmbando BP, Kamugisha ML, Rutta AM, Mandara CI, et al. Lost to follow up and clinical outcomes of HIV adult patients on antiretroviral therapy in care and treatment centres in Tanga City, north-eastern Tanzania. Tanzan Health Res. 2012;14(4):250–6.
Linthicum KJ, Anyamba A, Britch SC, Chretien JP, Erickson RL, Small J, et al. A Rift Valley fever risk surveillance system for Africa using remotely sensed data: potential for use on other continents. Vet Ital. 2007;43(3):663–74. PubMed
Fox MP, Rosen S. Patient retention in antiretroviral therapy programs up to 3 years on treatment in sub-Saharan Africa, 2007–2009: systematic review. Trop Medicine Int Health. 2010;15(Suppl 1):1–15. CrossRef
PROGRAM T. Community care for people living with HIV/AIDS and orphans/vulnerable children report. 2011.
Somi RG. Attrition from HIV care key operational challenge in implementing HIV care and treatment in Tanzania. Ministry of health and social welfare program (NACP); 2012.
Tweya H, Gugsa S, Hosseinipour M, Speight C, Ng’ambi W, Bokosi M, et al. Understanding factors, outcomes and reasons for loss to follow-up among women in Option B + PMTCT programme in Lilongwe, Malawi. Trop Med International Health. 2014;19(11):1360–6. CrossRef
WHO. Retention in HIV programmes: defining the challenges and identifying solutions. Geneva: World Health Organization. 2012.
Kalembo FW, Zgambo M. Loss to followup: a major challenge to successful implementation of prevention of mother-to-child transmission of HIV-1 programs in sub-Saharan Africa. Isrn Aids 2012ϕ. doi: 10.5402/2012/589817.
Gemechu B, Gerbi TH, Tameru B. Psychosocial factors as predictors of HIV/AIDS risky behaviors among people living with HIV/AIDS. J AIDS HIV Res. 2012;1:8–16.
Ribeiro C, Sarmento ECR, Dinis-Ribeiro M, Fernandes L. Effectiveness of psycho-educational intervention in HIV patients’ treatment. Front Psychiatr. 2014;5:198.
Cooperrider DLW. Appreciative Inquiry: a positive revolution in change. In: Holman P, Devane T, editors. The change handbook. Oakland: Berrett-Koehler Publishers, Inc.
Elspeth McAdam AW, Charles Steinberg, Kicki Oljemark, Keith McAdam. Namweza programme overview 2011. http://www.namweza.org/?page_id=145. Accessed 12 Feb 2017.
Program Nac. Implementation of HIV/AIDS care and treatment services in Tanzania report. 2013.
know TPt. SAS ® 9.3 Software 2011 (cited 16 Jun 2016). http://support.sas.com/software/93/. Accessed 19 Jan 2017.
Somi G. Attrition from HIV care key operational challenge. 2012. http://slideplayer.com/slide/7083119/. Accessed 10 Mar 2017.
Karfakis EKaJ. Current practices to increase uptake, retention and adherence for option B+ in Malawi. Mothers to mothers Malawi 2014 (cited 2016 August 26). https://www.m2m.org/wp-content/uploads/2014/10/m2m_Malawi-PMTCT-Report.pdf
- CLINICAL outcomes and loss to follow-up among people living with HIV participating in the NAMWEZA intervention in Dar es Salaam, Tanzania: a prospective cohort study
Hellen N. Siril
Sylvia F. Kaaya
Mary Kay Smith Fawzi
- BioMed Central
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