Multi-level Determinants of Starting ART Late: Aim 2

NCT ID: NCT01997346

Last Updated: 2014-12-16

Basic Information

• Recruitment Status: COMPLETED
• Total Enrollment: 136 participants
• Study Classification: OBSERVATIONAL
• Study Start Date: 2011-11-30
• Study Completion Date: 2011-12-31

Brief Summary

The availability of HIV care and treatment programs is increasing in sub-Saharan Africa. However more than half the patients who need HIV medicines are still not receiving this antiretroviral therapy (ART), and this can lead to early death from AIDS. One of the problems in this region is that patients start ART late, after the HIV disease is very advanced. This results in high death rates soon after ART initiation. The way clinic-level factors, such as the way services and referrals are organized, how referrals are regarded, counseling messages and record-keeping, contribute to late ART initiation is unclear. As the second phase of a 3-phase NIH-sponsored project, this study will identify clinic-level enablers and barriers to timely enrollment into HIV care and ART initiation. A cross-sectional qualitative study will be conducted at 4 selected HIV care and treatment clinics and the health facilities in which they are located in Ethiopia. Data will be collected using 4 methods:

1. Data abstraction

2. Key informant interviews with clinic personnel

3. Observation of post-test counseling sessions in the VCT clinic

4. Observation of provider-patient interactions in the care and treatment clinic Identifying modifiable health facility-level predictors of late ART initiation will facilitate implementation of interventions, programs and policies that will increase the number of patients who enroll in HIV care and initiate ART early. Additionally, results will inform the design of the third phase of the NIH-project referenced above.

Detailed Description

Background: Although HIV care and treatment programs are scaling up in sub-Saharan Africa, more than 50% of patients who need ART are not receiving it and significant mortality from AIDS persists. One major challenge in this region is high rates of late ART initiation (i.e., in the advanced stages of HIV disease) which results in high rates of mortality soon after ART initiation. The clinic-level factors that contribute to late ART initiation are unclear.

Objective: As the second of a 3-phase NIH-sponsored project, this study aims to identify clinic-level enablers and barriers to timely ART initiation.

Methods: A cross-sectional qualitative study will be conducted at 4 purposively selected HIV care and treatment clinics in Ethiopia. Data will be collected using 4 methods:

1. Data abstraction

2. Key informant interviews with clinic personnel

3. Observation of post-test counseling sessions at the voluntary counseling and testing (VCT) clinic

4. Observation of provider-patient interactions in the care and treatment clinic Descriptive statistics will be produced from the data abstraction. Content analysis of key informant interviews will be conducted. Descriptive summaries will be produced from observations. All analyses will focus on identifying within- and across-clinic themes, and include triangulation across data collection methods to identify clinic-level enablers and barriers to timely ART initiation.

Expected use of results: Identifying modifiable clinic-level enablers and barriers to timely ART initiation will facilitate implementation of interventions, programs and policies to reduce late ART initiation. Additionally, results will inform the third phase of the NIH-project referenced above.

Conditions

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

Keywords

ART initiation; Ethiopia; Clinic observation; VCT observation

Study Design

• Study Time Perspective: CROSS_SECTIONAL

Study Groups

Key Informant Interviews

We will conduct interviews with 4 clinic personnel (16 across the 4 sites) to learn about practices and provider perspectives in the HIV clinic or ancillary clinics such as VCT. The 4 clinic personnel in each site will include: the physician-in-charge, a nurse, one peer educator, and a nurse or community counselor from the VCT clinic. A semi-structured interview guide will be used to query respondents about: procedures for enrolling new clients, conducting active testing, identifying and initiating patients on ART, CD4 monitoring, tracking clients who have missed appointments, support programs, and peer education. We will also aim to understand how each respondent views her/his role, how s/he counsels patients on pre-ART care, and the challenges faced from each one's perspective.

No interventions assigned to this group

Eligibility Criteria

Inclusion Criteria

2. Key informant interviews

• ≥18 years of age;
• paid or voluntary employee in the 4 study sites for ≥6 months;
• and give verbal informed consent.

• Providers: ≥18 years of age; paid or voluntary employee in the 4 study sites for ≥6 months; responsible for HIV post-test counseling in VCT or PICT in the adult outpatient clinic; and give verbal informed consent
• Patients: ≥18 years of age; unaware of HIV status, and give verbal informed consent.

• Providers: ≥18 years of age; paid or voluntary employee in the care and treatment clinic of 4 study sites for ≥6 months; and give verbal consent.
• Patients: ≥18 years of age; not yet on ART (regardless of eligibility), receiving counseling or another service from one of the observed providers, and give verbal informed consent.

Exclusion Criteria

1. Data abstraction

• <18 years of age;
• employed at the 4 study sites <6 months;
• and/or not willing to give verbal consent.

3. Observation of post-test counseling sessions in the VCT clinic

• Providers: <18 years of age; employed <6 months; and/or not willing to give verbal consent.
• Patients: <18 years of age; and/or not willing to give verbal consent.

4. Observation of provider-patient interactions in the care and treatment clinic

• Providers: <18 years of age; employed <6 months; and/or not willing to give verbal consent.
• Patients: <18 years of age; and/or not willing to give verbal consent.

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

National Institute of Mental Health (NIMH)

NIH

Sponsor Role: collaborator

Columbia University

OTHER

Sponsor Role: lead

Responsible Party

Batya Elul

Assistant Professor of Clinical Epidemiology

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Batya Elul, PhD, MSc

Role: PRINCIPAL_INVESTIGATOR

ICAP-NY, Columbia University

Locations

Fitche Hospital

Fichē, , Ethiopia

Goba Hospital

Goba, , Ethiopia

Nekemte Hospital

Nekemte, , Ethiopia

Shashemene Hospital

Shashemenē, , Ethiopia

Countries

Ethiopia

Other Identifiers

1R01MH089831

Identifier Type: NIH

Identifier Source: secondary_id

View Link

AAAI1192

Identifier Type: -

Identifier Source: org_study_id