Assessing the impact of HIV support groups on antiretroviral therapy adherence and viral suppression in the African cohort study

Abstract

Background: Support groups for people living with HIV (PLWH) may improve HIV care adherence and outcomes. We assessed the impact of support group attendance on antiretroviral therapy (ART) adherence and viral suppression in four African countries.

Methods: The ongoing African Cohort Study (AFRICOS) enrolls participants at 12 clinics in Kenya, Uganda, Tanzania, and Nigeria. Self-reported attendance of any support group meetings, self-reported ART adherence, and HIV RNA are assessed every 6 months. Logistic regression models with generalized estimating equations were used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (95% CIs) for support group attendance and other factors potentially associated with ART adherence and viral suppression.

Results: From January 2013 to December 1, 2019, 1959 ART-experienced PLWH were enrolled and 320 (16.3%) reported any support group attendance prior to enrollment. Complete ART adherence, with no missed doses in the last 30 days, was reported by 87.8% while 92.4% had viral suppression <1000copies/mL across all available visits. There was no association between support group attendance and ART adherence in unadjusted (OR 1.01, 95% CI 0.99-1.03) or adjusted analyses (aOR 1.00, 95% CI 0.98-1.02). Compared to PLWH who did not report support group attendance, those who did had similar odds of viral suppression in unadjusted (OR 0.99, 95% CI 0.978-1.01) and adjusted analyses (aOR 0.99, 95% CI 0.97-1.01).

Conclusion: Support group attendance was not associated with significantly improved ART adherence or viral suppression, although low support group uptake may have limited our ability to detect a statistically significant impact.

Keywords: ART adherence; Africa; HIV; Support group; Viral suppression.

Fig. 1

HIV support group attendance in the African Cohort Study across different time points, from enrollment visit (month 0*) to month 42 (visit 8). Due to progressively small sample sizes in later visits, the data was censored at month 42 (visit 8) follow-up with 156 participants reporting support group attendance at this time point in the entire cohort. Chi-square tests were used to assess significant differences in self-reported support group attendance across and within sites over time. There was a statistically significant difference in inter-site self-reported support group attendance across different time points, p < 0.01. Significant within-site difference in self-reported support group attendance was observed in Kayunga, Uganda (p < 0.01), SRV, Kenya (p < 0.01), Tanzania (p = 0.01), and Nigeria (p = 0.02) but not in Kisumu West, Kenya (p = 0.63). *Month zero (0) is not the same time point for all participants, as it depended on their enrollment date (ranging from Jan 2013 to Nov 2019)