Title

Acceptability and preferences of two different community models of ART delivery in a high prevalence urban setting in Zambia, nested within the HPTN 071 (PopART) trial

Presenter

Mohammed Limbada

Authors

M. Limbada¹, S. Fidler², D. Macleod³, O. Shibwela¹, S. Floyd⁴, D. Nzara¹, V. Situmbeko¹, R. Hayes⁴, H. Ayles^1,5, on behalf of the HPTN 071 (PopART) Study Team

Institutions

¹Zambart (Zambia AIDS-Related TB Project), Lusaka, Zambia, ²Imperial College London, HIV Clinical Trials Unit, London, United Kingdom, ³London School og Hygiene and Tropical Medicine, Department of Infectious Disease Epidemiology, London, United Kingdom, ⁴London School of Hygiene and Tropical Medicine, Department of Infectious Disease Epidemiology, London, United Kingdom, ⁵London School of Hygiene and Tropical Medicine, Department of Infectious and Tropical Diseases, London, United Kingdom

Background: In high HIV-prevalence resource-limited settings with overburdened health care facilities, retention on ART and viral suppression are key challenges. Community models of ART delivery have shown promising outcomes in relation to retention in care and adherence to treatment. Within the HPTN 071(PopART) trial, two models of non-facility based ART delivery, either home-based delivery (HBD) or adherence clubs (AC), were offered and compared to facility-based delivery (standard of care, SoC) for stable HIV+ patients. We describe acceptability of the different models of ART delivery, and preferences reported by eligible residents offered them.
Methods: This was a three-arm cluster randomized non-inferiority trial comparing outcomes, including virological suppression, among patients offered HBD of ART or AC in two HPTN 071(PopART) trial communities in Lusaka, Zambia. The communities were divided into zones and each zone was randomized to one of the three delivery arms:
1. SoC,
2. a choice between HBD or SoC, or
3. choice between AC or SoC.
Stable HIV+ patients (defined according to WHO classification) living within the community zones were invited to take part in the study. Irrespective of the trial arm, all participants at baseline were asked to state their preference for mode of ART delivery.
Results: Between May and December 2017, the study identified 2535 stable patients who were eligible for community models of ART delivery across both communities and 2520 (99.4%) consented to join the study. Initial preferences, regardless of randomization arm, were expressed by 32.2% of participants. Of those that stated a preference, 70.3% stated they preferred HBD, 15.5% AC and 14.2% SoC. (Table 1). Among participants randomized to the choice of non-facility method of ART delivery, overall 95.6% chose the non-facility method that they were randomized to receive [96.8% in the HBD arm and 94.5% in the AC arm] (Fig1).
Conclusions: In this urban Zambian setting, stable HIV+ patients who expressed a preference preferred home based delivery of ART compared to adherence clubs or receiving treatment at the clinic. Patient preference should be considered when developing differentiated care delivery models.

[Figure 1: Acceptability and Choices of Community Models of ART Delivery]

	Number (N)	Percentage (%)
Total number of participants who consented to the study	2520	99.4
Total number who did NOT state a model preference	1709	67.8
Total number who stated a model preference	811	32.2
? Preferred Standard of Care	115	14.2
? Preferred Home Based Delivery	570	70.3
? Preferred Adherence Clubs	126	15.5

[Table 1: Participants? stated Preferences for Models of ART Delivery]

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