ART home delivery significantly improves viral suppression
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An ART home delivery program significantly increased viral suppression among patients with HIV in South Africa, according to study results presented at the Conference on Retroviruses and Opportunistic Infections.
“Simplifying ART delivery and monitoring can increase viral suppression,” Ruanne Barnabas, MBChB, DPhil, associate professor of global health and allergy and infectious diseases at the University of Washington, told Healio.
Barnabas and colleagues recruited 162 patients with HIV who were on ART or willing to initiate ART from Pietermaritzburg, South Africa, and randomly selected 82 to receive ART via home delivery for a fee. The remaining 80 participants received standard, clinic-based ART. The fee for home delivery was tiered based on the income of participants, and the study’s main outcomes were payment of the home delivery fee, acceptability of the delivery service and viral suppression.
The researchers worked with a routing scientist at Amazon to develop a routing algorithm to determine efficient delivery routes and prioritize patients who had a low supply of ART. The study was conducted from October 2019 to December 2021.
Of the participants, 62% (101) were on ART and 60% (98) were unemployed. Compared with standard care, home delivery increased viral suppression from 74% to 88% (RR = 1.21; 95% CI, 1.02-1.42). Among men, viral suppression increased from 64% to 84% (RR=1.31; 95% CI, 1.01-1.71). Viral suppression in South Africa is 64% among people living with HIV who receive standard clinical care.
COVID-19 restrictions did not affect patient retention, and the retention rate for all patients was 96%, according to the researchers. Among the patients who received home delivery ART, 98% paid the full fee and 100% reported a willingness to continue to pay the fee.
Barnabas said the study’s main limitation was its small sample size.
“The next step is to repeat this intervention at a larger scale,” Barnabas said.
Perspective
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Raghavendra Tirupathi, MD, FACP
Barnabas and colleagues provide here the proof of concept that home delivery of ART for a nominal fee and monitoring at home could, in turn, lead to higher ART adherence and better virologic outcomes. The effort was proven to be well accepted, affordable and cost-effective. This study is significant in highlighting the importance of removing barriers to care in people living with HIV, among which transportation to the nearest clinic could be a daunting task for many patients living in low- and middle-income countries. This has only been made worse by the pandemic. We in the United States also have lessons to learn from this experience where many people living with HIV have dropped out of care during the pandemic due to several reasons, including unemployment, lack of transportation, loss of health insurance and racial and ethnic disparities. Leveraging innovative approaches like the one in the study and technologic advances like telehealth would help us meet our patients where they are.
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Barnabas R, et al. Abstract 111. Presented at: Conference on Retroviruses and Opportunistic Infections; March 6-10, 2021 (virtual meeting).
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