BACKGROUND: Nagaland is a state in north-east India with a hilly terrain and an estimated HIV prevalence of 1.36% in 2021. With the long travel distance to Antiretroviral treatment (ART) centres as a barrier, nearly 20% of ART pickups are by proxy and usually by family members. To better systematize family member proxy pick- ups and improve quality of care, we initiated a family centric package of care by grouping families as a unit to align ART refill dates, engage family members as treatment supporters, and improve adherence and HIV-1 viral load suppression (VLS) rates.
METHODS: We initiated a family centric care (FCC) intervention in two high volume ART centres that account for 6% of ART patients in Nagaland. Counsellors at these ART centres systematically identified family members and allotted unique identification numbers to the family unit. We analysed the family size, proportion of families without aligned pill-pick-up dates, HIV VLS rates (<1,000 copies/ml). We calculated the proportion of Viral Load Coverage (VLC: defined as number of patients with viral load within the last 12 months) and VLS rates after three months of FCC for each family unit and compared the difference in proportion between family units with two and >2 family members.
RESULTS: From February to September 2022, we identified 942 families accounting for 27.4% (1,914/6,986) of the patients accessing ART from the two ART centers. The majority, 87% (819/942), were part of a two-member family, predominantly couples without children. Pill-pick-up dates were aligned for 660 (74%) families. After 3 months of FCC, VLC was 57% (66/161) and 84% (687/819); VL suppression was 86% (57/66) and 91% (62/68) among >2 member and two-member family units respectively. The difference in VLC was significant among two-member compared to >2-member family units [diff: 27%; p-<0.0001].
CONCLUSIONS: We observed increased viral load coverage among two-member family units compared to >2 family units in high volume ART centres as. It was easy to reach out to family units without children (majorly two-member family units) for VLC. Family Centric Care may be considered as a possible strategy to enhance VLC, and other HIV program indicators.