May 30, 2015
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Microclinics improve adherence to clinic care in HIV patients

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Social network-based interventions, known as microclinics, improved compliance to HIV management practices among Kenyan patients, according to recently published data.

The microclinics were used to promote HIV prevention, testing and treatment, as well as encourage patients with HIV to adhere to treatment. The researchers wrote that although ART is progressing in resource-limited countries, disengagement from HIV care remains a major setback.

“Microclinics are a novel approach in solving this problem, in large part because they directly and innovatively address the issue of stigma,” Matthew D. Hickey, BS, a graduating medical student at the University of California, San Francisco, said in a press release.

Researchers conducted a study in rural communities on Mfangano Island, Kenya, to determine the role of social support in HIV management. Researchers enrolled 369 patients with HIV between November 2011 and February 2012. Among them, 153 patients were enrolled in the intervention group, where each patient selected five to 15 family members or friends, with or without HIV, to support them and potentially help them form a microclinic.

The primary outcomes were clinic attendance and changes in nevirapine concentration in hair samples; secondary outcomes were changes in stigma associated with HIV. Patients who remained in the communities were followed for 22 months or until death.

Seventy-four percent of patients and their support groups within the intervention group joined a microclinic. Forty-four microclinics were formed (78% women; 33% HIV-infected). Ninety-seven percent of patients in the microclinics attended 10 interventions during a 5-month period, where they were encouraged to participate in HIV prevention and management. After the intervention, 86% of patients and support members participated in voluntary counseling, HIV testing and disclosure.

An intention-to-treat analysis showed that clinic absence for 90 days or more was reduced in the invention community vs. the controlled communities (HR = 0.53; 95% CI, 0.28-1.02), with a 90-day disengagement rate of 6.8 per 100 person-years in the intervention group vs. 12.9 per 100 person-years among controls. Results were similar after adjusting for initiation of ART and distance from the health facility (adjusted HR = 0.48; 95% CI, 0.25-0.92).

Further analysis demonstrated that intervention patients spent 17 more days “in care” per patient-year vs. controls (95% CI, 3-31), and 22 more days after adjusting for ART initiation, clinic distance and baseline HIV stigma (95% CI, 10-34).

Hair samples from patients (n = 338) remaining in the study at 6-month follow-up showed detectable nevirapine was reduced in both groups. In adjusted analysis, the intervention group had a decline of 6.7 ng/mg less than that of controls (95% CI, -2.7 to 16.1).

The researchers wrote that HIV stigma was reduced by 25% in the intervention group and was unchanged among controls.

“UNAIDS has set a goal aiming to have 90% of people with HIV in the world successfully treated and retained in care by 2020,” Craig R. Cohen, MD, MPH, professor of obstetrics, gynecology and reproductive sciences at UCSF, said in the release. “The microclinic intervention ... is a cost-effective, scalable initiative that could help governments meet their target.” - by Stephanie Viguers

Disclosure: The researchers report no relevant financial disclosures.