A Cluster Randomized Trial Evaluating a Care Model Adapted to People Living with HIV in Senegal
Assane Diouf
*
Service des Maladies Infectieuses et Tropicales, Centre Hospitalier National Universitaire de Fann, Dakar, Sénégal, Faculté de Médecine, de Pharmacie et d'Odontostomatologie, Université Cheikh Anta Diop, Dakar, Sénégal and Centre Régional de Recherche et de Formation à la Prise en Charge Clinique de Fann, Sénégal.
Aminata Massaly-Ndiaye
Service des Maladies Infectieuses et Tropicales, Centre Hospitalier National Universitaire de Fann, Dakar, Sénégal and Faculté de Médecine, de Pharmacie et d'Odontostomatologie, Université Cheikh Anta Diop, Dakar, Sénégal.
Ndeye Fatou Ngom
Outpatient Treatment Center, Fann Hospital, Dakar, Senegal and Department of Medicine, UFRSDD, University Alioune Diop, Bambey, Senegal.
Souleymane Jules Sow
Centre Régional de Recherche et de Formation à la Prise en Charge Clinique de Fann, Sénégal.
Ndeye Bineta Ndiaye-Coulibaly
Division of Fight against AIDS and Sexually Transmitted Infections, Ministry of Health, Dakar, Senegal.
Louise Fortes
Department of Infectious Diseases, Dalal Jamm National Hospital Center, Dakar, Senegal.
Ndeye Mery Dia-Badiane
Department of Infectious Diseases, UFR2S, Gaston Berger University, Saint Louis, Senegal.
Safiatou Thiam
National AIDS Council, Dakar, Senegal.
Moussa Seydi
Service des Maladies Infectieuses et Tropicales, Centre Hospitalier National Universitaire de Fann, Dakar, Sénégal and Faculté de Médecine, de Pharmacie et d'Odontostomatologie, Université Cheikh Anta Diop, Dakar, Sénégal.
*Author to whom correspondence should be addressed.
Abstract
Aims: To compare the retention rate of the ART-stable (on ART for ≥ 6 months with a stable condition) people living with HIV (PLHIV) between a care model adapted to PLHIVs (CMAP) combining task shifting and differentiated follow-up (intervention) .and the standard of care (control).
Study Design: Cluster randomized trial with both quantitative and qualitative components.
Place and Duration of Study: Between July 2017 and July 2019 in the 12 health districts of Saint and Tambacouda regions, Senegal.
Methodology: We included 1014 PLHIVs (429 in the intervention arm, 585 in the control arm). The mean age was 40.6 ± 13 years; 72% were female, 39.7% at WHO clinical stages 3-4. Arms were compared using Targeted Maximum Likelihood Estimation accounting for clustering.
A socio-anthropological survey was carried out among caregivers and PLHIVs through focus group discussions and interviews to elicit the perceptions on the CMAP. The interviews were subjected to thematic analysis with Atlas Ti
Results: After 18 months of follow-up, the retention rate was 94.4%(95% CI; = 93.8-96.2) in the CMAP arm versus 92.8% [95% CI = 90.2%-93.7%] in the control arm. The duration of the trip to the health facility (26 minutes vs 68 minutes; p <0.01), the transport costs (1 US$ vs 6 US$; p < 0.01) and the time spent in the health facility (31 minutes vs 89 minutes; p < 0.01) were lower in the intervention arm.
Six (6) focus groups and 25 interviews involving 42 caregivers and 28 PLHIVs were conducted in the CMAP arm. The qualitative analyses revealed that caregivers and PLHIVs were supportive of CMAP.
Conclusion: The CMAP was associated with increased retention, shorter travel time and decreased cost in HIV care
Keywords: Task shifting, differentiated care, HIV, Senegal