Pre-ART Retention in Care in Tanzania

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

Get a concise snapshot of the trial, including recruitment status, study phase, enrollment targets, and key timeline milestones.

Recruitment Status

COMPLETED

Total Enrollment

948 participants

Study Classification

OBSERVATIONAL

Study Start Date

2012-03-31

Study Completion Date

2016-02-29

Brief Summary

Review the sponsor-provided synopsis that highlights what the study is about and why it is being conducted.

Retention of patients in HIV care following diagnosis and enrollment is critical to the long-term success of HIV care and treatment scale-up. The goal of this study is to better understand the factors that influence retention and engagement in HIV care among adult patients who are enrolled in HIV care and are not yet eligible for antiretroviral therapy (ART). The study will be conducted at four HIV care and treatment clinics (CTCs) in Kagera Region, Tanzania. This is a mixed-methods study with both qualitative (interviews) and quantitative (surveys) data collection. Our findings will be important towards designing programs that help patients remain in HIV care.

Related Clinical Trials

Explore similar clinical trials based on study characteristics and research focus.

Examining HIV Treatment Adherence During Early Disease

NCT02419066

Medication Adherence HIV

COMPLETED

Multi-level Determinants of Starting ART Late: Aim 3

NCT01997359

Human Immunodeficiency Virus (HIV) Acquired Immune Deficiency Syndrome (AIDS)

COMPLETED

Measurement of Adherence to ART in HIV-Infected Children in Uganda (The CHARTA Study)

NCT00868257

HIV HIV Infections

COMPLETED

Immunosuppression in HIV-infected Patients With Tuberculosis in Ethiopia

NCT01252537

HIV Infection Tuberculosis Immunosuppression

COMPLETED

Interrupting HIV and TB Stigma in the Household in Uganda

NCT05124665

Hiv Tuberculosis Social Behavior +2 more

COMPLETED NA

Detailed Description

Dive into the extended narrative that explains the scientific background, objectives, and procedures in greater depth.

Retention of patients in HIV care following diagnosis and enrollment is a chronic challenge in both resource rich and resource poor settings (Rosen, Fox et al. 2007; WHO 2009; Fox and Rosen 2010), and is critical to the long-term success of HIV care and treatment scale-up. Most research on retention in care has focused on persons who are eligible for or have initiated antiretroviral therapy (ART), generally examined only demographic and clinical determinants. However, a large proportion of patients enrolled in HIV care (e.g., 45%, according to our data from 722 sub-Saharan African clinics) have not been determined to be ART-eligible and have not yet initiated ART; among these individuals, even less is known about the magnitude and determinants of non-retention in care. Retention in HIV care prior to ART initiation is a pre-requisite to: 1) optimal prophylaxis, diagnosis, and treatment of opportunistic illnesses (OIs); 2) effective secondary prevention of HIV transmission, such as by patient counseling and education, earlier diagnosis of infected family members and sexual partners, and prevention of mother to child transmission (PMTCT); and 3) more timely ART initiation. Retention in care among patients at earlier disease stages is also increasingly important given the WHO-recommended expansion of ART eligibility guidelines in resource-limited settings (WHO 2009).

Objective: The goal of this study is to better understand barriers and enablers to retention and engagement in HIV care among adult patients who are enrolled in HIV care and are not yet eligible for ART. The specific objectives are:

1. To describe themes in barriers and enablers to retention and engagement in HIV care;
2. To conduct structured interviews to gather relevant baseline information on potential determinants of non-retention and non-engagement in HIV care;
3. To estimate the incidence of short-term outcomes (missed visits and lost to follow-up (LTF)), including the rate and proportion of those LTF who are no longer engaged in HIV care; and
4. To identify determinants of missed visits, LTF, and non-engagement in care among ART-ineligible patients.

Methods: This study will be conducted using qualitative and quantitative methods at four HIV care and treatment clinics (CTCs) in Kagera Region, Tanzania.

1. Qualitative: in-depth interviews at two CTCs with up to 20 adult patients (ART naïve, and ineligible or indeterminate for ART) and about 4 health care workers; and focus group discussions (about 4 groups of about 6-10 persons/group) with adult patients (ART naïve, and ineligible or indeterminate for ART).
2. Quantitative: 1) structured baseline interviews at four CTCs (n= approximately 900 adult patients who are ART naïve, and ineligible or indeterminate for ART); 2) prospective monitoring of these 900 patients using routine CTC patient data to assess missed visits and LTF; and 4) brief structured surveys of patients who become LTF and are reached through defaulter tracing efforts.

Conditions

See the medical conditions and disease areas that this research is targeting or investigating.

HIV (Human Immunodeficiency Virus) AIDS (Acquired Immunodeficiency Syndrome)

Study Design

Understand how the trial is structured, including allocation methods, masking strategies, primary purpose, and other design elements.

Observational Model Type

ECOLOGIC_OR_COMMUNITY

Study Time Perspective

PROSPECTIVE

Study Groups

Review each arm or cohort in the study, along with the interventions and objectives associated with them.

In-depth Interview

Up to 20 in-depth interviews will be conducted among adult ART naïve patients, balanced by gender, site and reason for ART naiveté (determined ineligible or eligibility not yet determined) as much as possible. Up to 4 in-depth interviews will be conducted with health care providers.

No interventions assigned to this group

Focus Group Participants

Up to 40 patients ineligible or not yet eligible for ART will be invited to join a focus group discussion. Patients will be eligible for selection for either in-depth interviews or focus group discussions if they have made at least one prior visit to the clinic. Selected patients will be balanced as much as possible by gender and by pre-ART status (e.g. roughly half pre-ART eligibility determined, and roughly half pre-ART eligibility indeterminate).

No interventions assigned to this group

Prospective Cohort

Based on historical patient data from the four study CTCs, we expect that approximately 1,000 patients will enroll in HIV care at these clinics during the study period and be determined not eligible for ART or of unknown eligibility. Assuming a 10% refusal rate, approximately 900 patients would then enroll in this study and complete baseline interviews. These 900 patients will be prospectively monitored using routinely collected patient care data for up to 24 months. Outreach workers will attempt to trace all of the enrolled patients who are observed to be LTF during the study period, and complete a defaulter tracing survey.

No interventions assigned to this group

Eligibility Criteria

Check the participation requirements, including inclusion and exclusion rules, age limits, and whether healthy volunteers are accepted.

Inclusion Criteria

* ≥18 years of age
* ART naïve (unless for prior PMTCT)
* made at least one clinic visit prior to study enrollment
* unknown ART eligibility,
* willing to give informed consent.

* ≥18 years of age
* ART naïve (unless for prior PMTCT)
* made at least one clinic visit prior to study enrollment
* known ART ineligibility
* willing to give informed consent.

* ≥18 years of age
* have worked at that HIV clinic more than any other post within the hospital for at least 6 months
* medical officer, clinical officer or nurse
* willing to give informed consent.

* ≥18 years of age
* ART naïve (unless for prior PMTCT)
* enrolled in the study CTC
* ART-ineligible or of indeterminate ART eligibility
* willing to provide written informed consent,contact information and accept a home visit to verify outcomes if they become LTF.

Exclusion Criteria

* \<18 years of age
* initiated ART other than PMTCT prior to enrollment
* have known ART eligibility or ineligibility
* not willing to give informed consent.

ART-ineligible patients (n= approximately 10 in-depth and up to 20 focus group participants, where half are from a rural site, Mugana District Hospital and half are from an urban site, Nyakahanga District Hospital)

* \<18 years of age
* initiated ART other than PMTCT prior to enrollment
* have known ART eligibility
* not willing to give informed consent

Health care workers will be purposefully selected for participation according to the following criteria:

* \<18 years of age
* primarily posted at another clinic (just part-time or tempory assignment to HIV clinic)
* not willing to give informed consent

PROSPECTIVE COHORT

Patients that meet the following criteria will be included in the prospective study cohort:

* \<18 years of age
* initiated ART other than PMTCT prior to study enrollment
* ART eligible
* and/ or not willing to provide written informed consent, contact information or accept a home visit if LTF.

Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No