A Cluster Randomized Trial Evaluating a Care Model Adapted to People Living with HIV in Senegal

Abstract

Aims: To compare the retention rate of the ART-stable (on ART for ≥ 6 months with a stable condition) people living with HIV (PLHIV) between a care model adapted to PLHIVs (CMAP) combining task shifting and differentiated follow-up (intervention) .and the standard of care (control). Study Design: Cluster randomized trial with both quantitative and qualitative components. Place and Duration of Study: Between July 2017 and July 2019 in the 12 health districts of Saint and Tambacouda regions, Senegal. Methodology: We included 1014 PLHIVs (429 in the intervention arm, 585 in the control arm). The mean age was 40.6 ± 13 years; 72% were female, 39.7% at WHO clinical stages 3-4. Arms were compared using Targeted Maximum Likelihood Estimation accounting for clustering. A socio-anthropological survey was carried out among caregivers and PLHIVs through focus group discussions and interviews to elicit the perceptions on the CMAP. The interviews were subjected to thematic analysis with Atlas Ti Results: After 18 months of follow-up, the retention rate was 94.4%(95% CI; = 93.8-96.2) in the CMAP arm versus 92.8% [95% CI = 90.2%-93.7%] in the control arm. The duration of the trip to the health facility (26 minutes vs 68 minutes; p <0.01), the transport costs (1 US$ vs 6 US$; p < 0.01) and the time spent in the health facility (31 minutes vs 89 minutes; p < 0.01) were lower in the intervention arm. Six (6) focus groups and 25 interviews involving 42 caregivers and 28 PLHIVs were conducted in the CMAP arm. The qualitative analyses revealed that caregivers and PLHIVs were supportive of CMAP. Conclusion: The CMAP was associated with increased retention, shorter travel time and decreased cost in HIV care