The Video intervention to Inspire Treatment Adherence for Life (VITAL Start): protocol for a multisite randomized controlled trial of a brief video-based intervention to improve antiretroviral adherence and retention among HIV-infected pregnant women in Malawi.


Journal

Trials
ISSN: 1745-6215
Titre abrégé: Trials
Pays: England
ID NLM: 101263253

Informations de publication

Date de publication:
19 Feb 2020
Historique:
received: 14 11 2019
accepted: 01 02 2020
entrez: 21 2 2020
pubmed: 23 2 2020
medline: 19 12 2020
Statut: epublish

Résumé

Improving maternal antiretroviral therapy (ART) retention and adherence is a critical challenge facing prevention of mother-to-child transmission (PMTCT) of HIV programs. There is an urgent need for evidence-based, cost-effective, and scalable interventions to improve maternal adherence and retention that can be feasibly implemented in overburdened health systems. Brief video-based interventions are a promising but underutilized approach to this crisis. We describe a trial protocol to evaluate the effectiveness and implementation of a standardized educational video-based intervention targeting HIV-infected pregnant women that seeks to optimize their ART retention and adherence by providing a VITAL Start (Video intervention to Inspire Treatment Adherence for Life) before committing to lifelong ART. This study is a multisite parallel group, randomized controlled trial assessing the effectiveness of a brief facility-based video intervention to optimize retention and adherence to ART among pregnant women living with HIV in Malawi. A total of 892 pregnant women living with HIV and not yet on ART will be randomized to standard-of-care pre-ART counseling or VITAL Start. The primary outcome is a composite of retention and adherence (viral load < 1000 copies/ml) 12 months after starting ART. Secondary outcomes include assessments of behavioral adherence (self-reported adherence, pharmacy refill, and tenofovir diphosphate concentration), psychosocial impact, and resource utilization. We will also examine the implementation of VITAL Start via surveys and qualitative interviews with patients, partners, and health care workers and conduct cost-effectiveness analyses. This is a robust evaluation of an innovative facility-based video intervention for pregnant women living with HIV, with the potential to improve maternal and infant outcomes. ClinicalTrials.gov, NCT03654898. Registered on 31 August 2018.

Sections du résumé

BACKGROUND BACKGROUND
Improving maternal antiretroviral therapy (ART) retention and adherence is a critical challenge facing prevention of mother-to-child transmission (PMTCT) of HIV programs. There is an urgent need for evidence-based, cost-effective, and scalable interventions to improve maternal adherence and retention that can be feasibly implemented in overburdened health systems. Brief video-based interventions are a promising but underutilized approach to this crisis. We describe a trial protocol to evaluate the effectiveness and implementation of a standardized educational video-based intervention targeting HIV-infected pregnant women that seeks to optimize their ART retention and adherence by providing a VITAL Start (Video intervention to Inspire Treatment Adherence for Life) before committing to lifelong ART.
METHODS METHODS
This study is a multisite parallel group, randomized controlled trial assessing the effectiveness of a brief facility-based video intervention to optimize retention and adherence to ART among pregnant women living with HIV in Malawi. A total of 892 pregnant women living with HIV and not yet on ART will be randomized to standard-of-care pre-ART counseling or VITAL Start. The primary outcome is a composite of retention and adherence (viral load < 1000 copies/ml) 12 months after starting ART. Secondary outcomes include assessments of behavioral adherence (self-reported adherence, pharmacy refill, and tenofovir diphosphate concentration), psychosocial impact, and resource utilization. We will also examine the implementation of VITAL Start via surveys and qualitative interviews with patients, partners, and health care workers and conduct cost-effectiveness analyses.
DISCUSSION CONCLUSIONS
This is a robust evaluation of an innovative facility-based video intervention for pregnant women living with HIV, with the potential to improve maternal and infant outcomes.
TRIAL REGISTRATION BACKGROUND
ClinicalTrials.gov, NCT03654898. Registered on 31 August 2018.

Identifiants

pubmed: 32075677
doi: 10.1186/s13063-020-4131-8
pii: 10.1186/s13063-020-4131-8
pmc: PMC7031891
doi:

Substances chimiques

Anti-HIV Agents 0

Banques de données

ClinicalTrials.gov
['NCT03654898']

Types de publication

Clinical Trial Protocol Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

207

Subventions

Organisme : FIC NIH HHS
ID : K01 TW009644
Pays : United States
Organisme : NIMH NIH HHS
ID : R01 MH115793
Pays : United States

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Auteurs

Maria H Kim (MH)

Baylor College of Medicine International Pediatric AIDS Initiative, Texas Children's Hospital, Houston, TX, USA. mhkim@bcm.edu.
Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi. mhkim@bcm.edu.

Tapiwa A Tembo (TA)

Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi.

Alick Mazenga (A)

Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi.

Xiaoying Yu (X)

University of Texas Medical Branch at Galveston, Galveston, TX, USA.

Landon Myer (L)

Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.

Rachael Sabelli (R)

Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi.

Robert Flick (R)

Baylor College of Medicine International Pediatric AIDS Initiative, Texas Children's Hospital, Houston, TX, USA.
Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi.

Miriam Hartig (M)

Baylor College of Medicine International Pediatric AIDS Initiative, Texas Children's Hospital, Houston, TX, USA.
Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi.

Elizabeth Wetzel (E)

Baylor College of Medicine International Pediatric AIDS Initiative, Texas Children's Hospital, Houston, TX, USA.
Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi.

Katie Simon (K)

Baylor College of Medicine International Pediatric AIDS Initiative, Texas Children's Hospital, Houston, TX, USA.
Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi.

Saeed Ahmed (S)

Baylor College of Medicine International Pediatric AIDS Initiative, Texas Children's Hospital, Houston, TX, USA.
Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi.

Rose Nyirenda (R)

HIV Unit, Malawi Ministry of Health, Lilongwe, Malawi.

Peter N Kazembe (PN)

Baylor College of Medicine International Pediatric AIDS Initiative, Texas Children's Hospital, Houston, TX, USA.
Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi.

Mtisunge Mphande (M)

Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi.

Angella Mkandawire (A)

Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi.

Mike J Chitani (MJ)

Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi.

Christine Markham (C)

Health Promotion & Behavioral Sciences, The University of Texas School of Public Health, Houston, TX, USA.

Andrea Ciaranello (A)

Division of Infectious Diseases, Department of Medicine; Medical Practice Evaluation Center; both at Massachusetts General Hospital, Boston, MA, USA.

Elaine J Abrams (EJ)

ICAP at Columbia, Mailman School of Public Health and Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA.

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Classifications MeSH