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Effectiveness of a Peer Educator-Coordinated Preference-Based Differentiated Delivery Model on Viral Suppression Among Young People Living with HIV in Lesotho: The PEBRA Cluster Randomized Trial
22 Pages Posted: 27 Jan 2022
More...Abstract
Background: Southern and Eastern Africa are home to more than 2.1 million young people living with HIV. As compared with other age groups, they have poorer outcomes along the HIV care cascade. The PEBRA (Peer Educator-Based Refill of ART) cluster-randomized trial compared a preference-based youth service delivery model coordinated by peer educators versus standard clinic care in three districts in Lesotho.
Methods: Individuals taking antiretroviral therapy aged 15-24 years at 20 clinics (clusters) were eligible. In clinic-clusters randomized to the intervention arm, participants were offered the PEBRA model: a peer educator regularly assessed their preferences regarding medication pick-up, SMS notifications and psychosocial support options, and delivered services accordingly. In control clusters, participants were offered standard nurse-coordinated care. The primary endpoint was 12-month viral suppression below 20 copies/mL. Analyses were intention-to-treat. C
Findings: From November 6th, 2019, until February 4th, 2020, we enrolled 307 individuals (150 intervention, 157 control; 218 [71%] female, median age 19 years [interquartile range 17-22]). At 12 months, 99 of 150 (66%) participants in the intervention versus 95 of 157 (61%) participants in the control arm had viral suppression (adjusted odds ratio 1.27 [95%CI -0.67-1.86]); 4 of 150 (2.7%) versus 1 of 157 (0.6%) had died (adjusted odds ratio 4.12 [95%CI -4.99-13.23]); and 12 of 150 (8%) versus 23 of 157 (14.7%) had transferred out (adjusted odds ratio 0.53 [95%CI 0.14-0.93]).
Interpretation: Preference-based peer-coordinated care for young people living with HIV is feasible and led to fewer transfers to other clinics but similar virological outcomes as nurse-based care only.
Trial Registration Details: Registered with ClinicalTrials.gov (https://clinicaltrials.gov/ct2/show/NCT03969030; prospectively registered on May 31, 2019).
Funding Information: This trial is predominantly funded by the CIPHER grant from the International AIDS Society, obtained by AA. The Swiss Institute of Tropical and Public Health is the sponsor of the study. AA received his salary through a grant from the MD-PhD program of the Swiss National Science Foundation (Grant 323530_177576). The study is embedded in the SolidarMed and Sentebale country programs and thus benefits from their logistics, administration and human resources.
Declaration of Interests: The authors declare that they have no competing interests.
Ethics Approval Statement: This trial was approved by the National Health Research and Ethics Committee of the Ministry of Health of Lesotho (118–2019; June 03, 2019) and an ethics committee in Switzerland (Ethikkommission Nordwest- und Zentralschweiz; 2019-00480; June 14, 2019).
Keywords: Africa, Southern, Lesotho, HIV, differentiated service delivery, DSD, adolescent, young people, viral suppression, delivery of health care, peer-support, peer-group
Suggested Citation: Suggested Citation