Abstract:
BACKGROUND : Only 66% of South African people living with HIV (PLWH) are virologically
suppressed. Therefore, it is important to develop strategies to improve outcomes.
OBJECTIVES : Assess the effect of interventions on 12-month retention in care and virological
suppression in participants newly initiated on antiretroviral therapy.
METHOD : Fifty-seven clinics were randomised into four arms: Ward-based primary health care
outreach teams (WBPHCOTs); Game; WBPHCOT–Game in combination; and Control
(standard of care). Sixteen clinics were excluded and four re-allocated because lay counsellors
and operational team leaders failed to attend the required training. Seventeen clinics were
excluded due to non-enrolment.
RESULTS : A total of 558 participants from Tshwane district were enrolled. After excluding
ineligible participants, 467 participants were included in the analysis: WBPHCOTs
(n = 72); Games (n = 126); WBPHCOT–Games (n = 85); and Control (n = 184). Retention in care
at 12 months was evaluable in 340 participants (86.2%) were retained in care and 13.8% were
lost to follow-up. The intervention groups had higher retention in care than the Control group,
but this only reached statistical significance in the Games group (96.8% vs 77.8%; relative risk
[RR] 1.25; 95% confidence interval [CI]: 1.13–1.38; P = 0.01). The 12 month virologic suppression
rate was 75.3% and was similar across the four arms.
CONCLUSION : This study demonstrated that an adherence game intervention could help keep
PLWH in care.
WHAT THIS STUDY ADDS : Evidence that interventions, especially Games, could improve retention
in care.
