Thematic Window 7 Integration of HIV Services Award Winners

3ie is pleased to announce five awards under 3ie’s seventh Thematic Window on Integration of HIV services in Sub-Saharan Africa.

This window aims to bridge the knowledge gap of what works and why in HIV care and treatment, and specifically whether and how integration of health services could be a major tool to address the HIV and AIDS treatment cascade.

The awards made under this grant window will fund projects that include pilot interventions and impact evaluations of under-researched HIV service integration programmes that aim to improve linkage to care, adherence and/or retention, with the purpose of contributing to better understanding of what works, why, through what channels and at what cost to maximise policy relevance and impact.

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Awards

Design and implementation of a chronic care model to improve prevention, care and support for people living with HIV in Côte d’Ivoire

Principal investigator: Stacie C. Stender
Organisation: Jhpiego

The study seeks to evaluate the impact of an integrated chronic care model on adult adherence and retention rates in Côte d’Ivoire. The evaluation will be conducted within a five-year US$5 million pilot intervention funded by the Center for Disease Control and Prevention. In addition to adherence and retention, the study will evaluate several secondary outcomes including screenings for tuberculosis, sexually transmitted infections, hypertension and provision of family planning services.

The study has a quasi-experimental pre-test post-test design in which one region of intervention, N’zi-Ifou, will be matched with comparison sites in a neighbouring region not receiving the intervention, Indenie-Djuablin. A total of approximately 553 participants attending seven intervention and seven control health facilities will be included in the study. The intervention group will receive a patient-centred, family-focused minimum package of care at each visit. In addition, health providers in these facilities will be trained and mentored. At six months, quantitative and qualitative data will be collected from both patients and health providers. Evidence from this study will provide significant insight into how best to address HIV and AIDS outcomes and service delivery.

Integration of expanded programme for immunisation and pediatric HIV services for improved coverage and patient outcomes in Zimbabwe

Principal investigators: Alexio Mangwiro and Brett Keller
Organisation:Clinton Health Access Initiative

The study seeks to evaluate the impact of integrating early infant diagnosis of HIV into the expanded programme for immunisation (EPI) on antiretroviral therapy (ART) initiation among infants (aged greater than or equal to 16 weeks) in Zimbabwe. A cluster-randomised controlled trial will be implemented in 20 paediatric ART-initiating sites (ten each in the intervention and control groups). Over the course of the intervention, there will be an estimated 29,082 EPI visits and 447 ART initiations. For the intervention group, mother and infant pairs who come for the six-week EPI visit will be offered home-testing and counselling (HTC) services and health education. If accepted, the programme aims to improve turn-around time and enable receiving test results at the next EPI visit. If the mother and/or infant tests positive, they will be referred immediately to ART services. The study will provide the intervention facilities with the supplies, personnel training and sample transport needed to ensure improvements in the integration of services. The success of the linkage programme will be assessed by comparing the number of infants coming in for DPT1 vaccine at approximately six weeks of age, with the number of ART initiations at greater than or equal to 16 weeks. At three and six months, quantitative and qualitative data will be collected from the health facilities and participants. Evidence from this study will provide significant insight into the feasibility, benefits and challenges of integration.

Improving adherence to ART at maternal and child health clinics integrating Option B+ in Tanzania

Principal investigators: John Chalker and Dennis Ross-Degnan
Organisation: Management Services for Health

The study seeks to evaluate the impact of introducing an appointment and patient-tracking system on HIV-positive women’s adherence to appointments and ART continuity in Tanzania in maternal and child health (MCH) clinics integrated with Option B+, a programme that continues ART care for pregnant and post-partum women for the rest of their lives. Secondary outcomes of interest include loss to follow-up (>60 days), medication possession ratio, perceptions about clinic efficiency and patient engagement with care. A cluster-randomised controlled trial will be implemented in 24 MCH clinics in the Mbeya region (12 each in the intervention and control groups). The intervention facilities will receive training on a standardised appointment system. The system will allow the facility staff to track patient preferences, missed appointments, appointments missed by more than three days and identify and follow up with patients that have missed an appointment. At seven months, quantitative and qualitative data will be collected from the health facilities and participants.

The study intends to address some of the individual and system-level barriers to ART adherence including wait times at the clinic, forgetfulness, stigma and social support. Evidence from this study will provide insight into effectively improving adherence and retention rates for a national programme.

Integration of HIV services into a community-based health programme in Tanzania

Principal investigators: Till Bärnighausen and Nan Li
Organisation: Harvard School of Public Health

The study seeks to evaluate the impact of integrating HIV services into an existing community-based health programme on patient adherence, retention, and access to services in Dar es Salaam, Tanzania. The study will also examine health system capacity and efficiency and the performance of the integrated service delivery. A cluster-randomised controlled trial will be implemented in 80 streets in the Temeke district (40 each in the intervention and control groups). Two teams of health workers, home-based carers (HBC) and community-based health care workers (CBHC), will conduct monthly home visits and promote community engagement. In intervention areas, HBCs and CBHCs will specifically target people living with HIV to provide HTC and ART adherence support and assist in ART patient enrollment and follow-up. CBHCs will be receiving training on community health work—patient confidentiality, data management and communication skills and counseling techniques, with HBCs in the intervention areas receiving an additional three modules focused on HIV care support (loss-to-follow up, adherence and unmet need for HIV treatment and care, rapid HIV test administration and support, ART delivery and HIV knowledge education, with refresher training at four months. At 11 months, quantitative and qualitative data will be collected from the health facilities and participants on service utilisation and programme delivery outcomes. Evidence from this study will inform government efforts to scale up community-based health programmes.

Integration of community maternal, newborn and child health services with prevention of mother-to-child HIV Transmission using community health workers to enhance retention in care and improve adherence to antiretroviral therapy in Tanzania

Principal investigator: Sandra McCoy
Organisation: Amref Health Africa

This study seeks to evaluate the impact of a pilot programme that uses community health workers (CHWs) in integrating maternal, newborn and child health (MNCH) services and prevention of mother-to-child transmission of HIV (PMTCT) services in Tanzania. The primary outcomes of interest include initiation of ART, the proportion of HIV-infected pregnant women who are retained in care at 90 days post-partum and adherence to ART.

The study uses a cluster randomised design in which 30 villages in the Shinyanga region of Tanzania will be allocated to the treatment or control group. A total of 60 CHWs (two per village) are expected to participate. In the treatment group, CHWs will be formally linked with reproductive and child health (RCH) facilities. They will receive mentorship, supportive supervision and coordination of tasks. These CHWs will then be tasked with distributing Action Birth Cards to HIV-positive and HIV-negative pregnant woman. The cards are an interactive planning tool that link MNCH services with PMTCT services and HIV treatment. CHWs will also provide monthly adherence counselling to women on ART, and will help trace HIV-positive women who are lost to follow-up. At nine months, quantitative and qualitative data will be collected from participants, CHWs and facilities.

Preventing attrition from the treatment and care cascade and improving adherence is critically important as Tanzania begins scaling up Option B+. Evidence from this study will provide significantinsight into how best to address HIV and AIDS outcomes among pregnant and postpartum women. 

Photo © Elizabeth Glaser/Pediatric AIDS Foundation

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