Title

Can a behavioral science-informed therapeutic alliance be the answer to attaining the third 95 Global UNAIDS target? Promising results from a viral load study involving children on ART in Zambia

Presenter

Adamson Paxon Ndhlovu

Authors

A.P. Ndhlovu¹, M. McKay², L. Kawanga³, M. Nyumbu⁴, M. Musonda⁵

Institutions

¹JSI Research & Training Institute, Technical Services, Lusaka, Zambia, ²JSI Research & Training Institute, Boston, United States, ³JSI Research & Training Institute, Technical Services, Ndola, Zambia, ⁴JSI Research & Training Institute, Administration, Lusaka, Zambia, ⁵US Embassy/Zambia Mission, Lusaka, Zambia

BACKGROUND: Globally, 52% of the 1.7 million children living with HIV (CLHIV) aged 0-14 years received ART in 2021, but only 4 in 10 were virally suppressed (UNICEF 2022). CLHIV on ART are more likely to be virally non-suppressed due to clinical and behavioral aspects, e.g., poor adherence, non-optimized antiretrovirals (ARVs) and severe immunosuppression. We aimed to determine the impact of a behavioral science-informed therapeutic alliance (TA) on viral non-suppression among CLHIV in USAID DISCOVER-Health-supported facilities in two provinces of Zambia.
METHODS: Non-suppressed CLHIV on dolutegravir-containing ART for >6 months and assigned to a TA comprising a clinician, oriented community-based volunteer (CBV) and a household caregiver as standard care were enrolled in the study. The intervention arm enrolled CLHIV from 8 of the 15 districts, also assigned to a TA, but layered behavioral science informed approaches targeted at decision making biases and social/organizational norms:

CBVs directly supported caregivers administering ARVs every week, uncovering and addressing barriers to adherence;.
Clinicians supported CBVs and submitted progress reports to supervisors and discussed challenges and remedies monthly.

Cascade data for CLHIV enrolled in enhanced adherence counseling (EAC) to viral suppression outcomes were collected for analysis with WINPEPI.
RESULTS: The study enrolled 188 non-suppressed CLHIV in November 2022. After 4 months, 177 CLHIV (94%) were enrolled in EAC with 89% completion rate. Additionally, 140 CLHIV underwent repeat VL testing with 25% viral non-suppression rate. No significant differences were observed in EAC enrolment (p=0.412) or completion rates (p=0.556) between the two study arms. VL retesting after EAC completion was statistically significantly higher in the intervention arm (risk ratio (RR)=1.12; CI=1.01-1.26, p=0.026). The risk of viral non-suppression was two-times less in the intervention arm (RR=0.472; CI=0.25-0.89, p=0.012) compared with standard care.
CONCLUSIONS: Applying behavioral science to TAs spearheading pediatric ART service provision can lead to optimized clinician and caregiver behavior, which increases positive treatment outcomes and reduces viral non-suppression. Applying behavioral science in such settings is crucial to achieving the goal of ending AIDS in children by 2030.

Download the e-Poster (PDF)