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. 2024 Jan 9:7:119.
doi: 10.12688/gatesopenres.14682.2. eCollection 2023.

Preferences for services in a patient's first six months on antiretroviral therapy for HIV in South Africa and Zambia (PREFER): research protocol for a prospective observational cohort study

Mhairi Maskew  1 , Vinolia Ntjikelane  1 , Allison Juntunen  2 , Nancy Scott  2 , Mariet Benade  1   2   3 , Linda Sande  1 , Pamfred Hasweeka  4 , Prudence Haimbe  4 , Priscilla Lumano-Mulenga  5 , Hilda Shakewelele  4 , Mpande Mukumbwa-Mwenechanya  6 , Sydney Rosen  1   2
Affiliations

Preferences for services in a patient's first six months on antiretroviral therapy for HIV in South Africa and Zambia (PREFER): research protocol for a prospective observational cohort study

Mhairi Maskew et al. Gates Open Res. .

Abstract

Background: For patients on HIV treatment in sub-Saharan Africa, the highest risk for loss from care remains the first six months after antiretroviral (ART) initiation, when patients are not yet eligible for differentiated service delivery (DSD) models that offer lower-burden, patient-centred care and thus improve treatment outcomes. To reduce early disengagement from care, the PREFER study will use a sequential mixed-methods approach to describe the characteristics, needs, concerns, and preferences of patients in South Africa and Zambia 0-6 months after ART initiation or re-initiation.

Protocol: PREFER is an observational, prospective cohort study of adults on ART for ≤6 months at 12 public healthcare facilities in Zambia and 18 in South Africa. Its objective is to describe and understand the needs and preferences of initiating and re-initiating ART clients to inform the design of DSD models for the early HIV treatment period, improve early treatment outcomes, and distinguish the barriers encountered by naïve patients from those facing re-initiators. It has four components: 1) survey of clients 0-6 months after ART initiation (identify characteristics and preferences of clients starting ART); 2) follow up through routinely collected medical records for <24 months after enrollment (describe resource utilization and patterns and predictors of engagement in care); 3) focus group discussions and discrete choice experiment (explore reported barriers to and facilitators of retention); and 4) in South Africa only, collection of blood samples (assess the prevalence of ARV metabolites indicating prior ART use).

Conclusions: PREFER aims to understand why the early treatment period is so challenging and how service delivery can be amended to address the obstacles that lead to early disengagement from care. It will generate information about client characteristics and preferences to help respond to patients' needs and design better strategies for service delivery and improve resource allocation going forward.

Keywords: HIV; South Africa; Zambia; antiretroviral therapy; models of care; retention.

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Conflict of interest statement

Competing interests: No competing interests were disclosed. PLM holds a position in a government agency that has supervisory authority over some of the healthcare facilities involved in this study.

Figures

Figure 1.
Figure 1.. Components and flow of the PREFER study.
See this image and copyright information in PMC

References

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