Randomized Controlled Trial

. 2021 Apr;25(4):1129-1143.

doi: 10.1007/s10461-020-03063-1. Epub 2020 Oct 30.

The Treatment Ambassador Program: A Highly Acceptable and Feasible Community-Based Peer Intervention for South Africans Living with HIV Who Delay or Discontinue Antiretroviral Therapy

Ingrid T Katz^{1

2

3

4

5}, Laura M Bogart⁶, Garrett M Fitzmaurice^{7

8

9

10}, Vincent S Staggs^{11

12}, Marya V Gwadz¹³, Ingrid V Bassett^{8

14}, Anna Cross¹⁵, Ingrid Courtney¹⁵, Lungiswa Tsolekile¹⁶, Regina Panda¹⁵, Sonja Steck⁷, David R Bangsberg¹⁷, Catherine Orrell^#¹⁵, Kathy Goggin^#^{11

12

18}

Affiliations

¹ Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA. ikatz2@bwh.harvard.edu.
² Harvard Medical School, Boston, MA, USA. ikatz2@bwh.harvard.edu.
³ Massachusetts General Hospital Center for Global Health, Boston, MA, USA. ikatz2@bwh.harvard.edu.
⁴ Harvard Global Health Institute, Cambridge, MA, USA. ikatz2@bwh.harvard.edu.
⁵ Division of Women's Health, Brigham and Women's Hospital, 1620 Tremont St. - 3rd Floor, Boston, MA, 02120, USA. ikatz2@bwh.harvard.edu.
⁶ RAND Corporation, Santa Monica, CA, USA.
⁷ Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
⁸ Harvard Medical School, Boston, MA, USA.
⁹ Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
¹⁰ Laboratory for Psychiatric Biostatistics, McLean Hospital, Belmont, MA, USA.
¹¹ Health Services and Outcomes Research, Children's Mercy Kansas City, Kansas City, MO, USA.
¹² School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA.
¹³ Silver School of Social Work, New York University, New York, NY, USA.
¹⁴ Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
¹⁵ Desmond Tutu HIV Foundation, University of Cape Town Medical School, Cape Town, South Africa.
¹⁶ School of Public Health, University of the Western Cape, Cape Town, South Africa.
¹⁷ Oregon Health & Science University-Portland State University School of Public Health, Portland, OR, USA.
¹⁸ School of Pharmacy, University of Missouri-Kansas City, Kansas City, MO, USA.

^# Contributed equally.

PMID: 33125587
PMCID: PMC7979476
DOI: 10.1007/s10461-020-03063-1

Randomized Controlled Trial

The Treatment Ambassador Program: A Highly Acceptable and Feasible Community-Based Peer Intervention for South Africans Living with HIV Who Delay or Discontinue Antiretroviral Therapy

Ingrid T Katz et al. AIDS Behav. 2021 Apr.

. 2021 Apr;25(4):1129-1143.

doi: 10.1007/s10461-020-03063-1. Epub 2020 Oct 30.

Authors

Affiliations

¹ Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA. ikatz2@bwh.harvard.edu.
² Harvard Medical School, Boston, MA, USA. ikatz2@bwh.harvard.edu.
³ Massachusetts General Hospital Center for Global Health, Boston, MA, USA. ikatz2@bwh.harvard.edu.
⁴ Harvard Global Health Institute, Cambridge, MA, USA. ikatz2@bwh.harvard.edu.
⁵ Division of Women's Health, Brigham and Women's Hospital, 1620 Tremont St. - 3rd Floor, Boston, MA, 02120, USA. ikatz2@bwh.harvard.edu.
⁶ RAND Corporation, Santa Monica, CA, USA.
⁷ Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
⁸ Harvard Medical School, Boston, MA, USA.
⁹ Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
¹⁰ Laboratory for Psychiatric Biostatistics, McLean Hospital, Belmont, MA, USA.
¹¹ Health Services and Outcomes Research, Children's Mercy Kansas City, Kansas City, MO, USA.
¹² School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA.
¹³ Silver School of Social Work, New York University, New York, NY, USA.
¹⁴ Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
¹⁵ Desmond Tutu HIV Foundation, University of Cape Town Medical School, Cape Town, South Africa.
¹⁶ School of Public Health, University of the Western Cape, Cape Town, South Africa.
¹⁷ Oregon Health & Science University-Portland State University School of Public Health, Portland, OR, USA.
¹⁸ School of Pharmacy, University of Missouri-Kansas City, Kansas City, MO, USA.

^# Contributed equally.

PMID: 33125587
PMCID: PMC7979476
DOI: 10.1007/s10461-020-03063-1

Abstract

We conducted a novel pilot randomized controlled trial of the Treatment Ambassador Program (TAP), an 8-session, peer-based, behavioral intervention for people with HIV (PWH) in South Africa not on antiretroviral therapy (ART). PWH (43 intervention, 41 controls) completed baseline, 3- and 6-month assessments. TAP was highly feasible (90% completion), with peer counselors demonstrating good intervention fidelity. Post-intervention interviews showed high acceptability of TAP and counselors, who supported autonomy, assisted with clinical navigation, and provided psychosocial support. Intention-to-treat analyses indicated increased ART initiation by 3 months in the intervention vs. control arm (12.2% [5/41] vs. 2.3% [1/43], Fisher exact p-value = 0.105; Cohen's h = 0.41). Among those previously on ART (off for > 6 months), 33.3% initiated ART by 3 months in the intervention vs. 14.3% in the control arm (Cohen's h = 0.45). Results suggest that TAP was highly acceptable and feasible among PWH not on ART.

Keywords: ART initiation; Behavioral intervention; Differentiated service delivery; Engagement in care; Motivational interviewing; Peer-based intervention; South Africa.

PubMed Disclaimer

Figures

Figure 1:. Conceptual Model of Treatment Ambassador Program (TAP)*
*Based on our explanatory Framework of ART Refusal

**Figure 2:**
Study Enrollment – CONSORT diagram

See this image and copyright information in PMC

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References

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The Treatment Ambassador Program: A Highly Acceptable and Feasible Community-Based Peer Intervention for South Africans Living with HIV Who Delay or Discontinue Antiretroviral Therapy

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The Treatment Ambassador Program: A Highly Acceptable and Feasible Community-Based Peer Intervention for South Africans Living with HIV Who Delay or Discontinue Antiretroviral Therapy

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