The Treatment Ambassador Program: A Highly Acceptable and Feasible Community-Based Peer Intervention for South Africans
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ORIGINAL PAPER
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. Katz1,2,3,4,16 · Laura M. Bogart5 · Garrett M. Fitzmaurice1,2,6,7 · Vincent S. Staggs8,9 · Marya V. Gwadz10 · Ingrid V. Bassett2,11 · Anna Cross12 · Ingrid Courtney12 · Lungiswa Tsolekile13 · Regina Panda12 · Sonja Steck1 · David R. Bangsberg14 · Catherine Orrell12 · Kathy Goggin8,9,15 Accepted: 8 October 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract We conducted a novel pilot randomized controlled trial of the Treatment Ambassador Program (TAP), an 8-session, peerbased, 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. Intentionto-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 Engagement in care · South Africa · ART initiation · Motivational interviewing · Peer-based intervention · Behavioral intervention · Differentiated service delivery
Catherine Orrell and Kathy Goggin shared senior authorships. * Ingrid T. Katz [email protected] 1
10
Silver School of Social Work, New York University, New York, NY, USA
11
Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
12
Desmond Tutu HIV Foundation, University of Cape Town Medical School, Cape Town, South Africa
Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
2
Harvard Medical School, Boston, MA, USA
3
Massachusetts General Hospital Center for Global Health, Boston, MA, USA
13
4
Harvard Global Health Institute, Cambridge, MA, USA
School of Public Health, University of the Western Cape, Cape Town, South Africa
14
5
RAND Corporation, Santa Monica, CA, USA
Oregon Health & Science University-Portland State University School of Public Health, Portland, OR, USA
6
Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
15
School of Pharmacy, University of Missouri-Kansas City, Kansas City, MO, USA
7
Laboratory for Psychiatric Biostatistics, McLean Hospital, Belmont, MA, USA
16
8
Health Services and Outcomes Research, Children’s Mercy Kansas City, Kansas City, MO, USA
Division of Women’s Health, Brigham and Women’s Hospital, 1620 Tremont St.
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