Understanding how partnerships help with ART adherence

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As more countries recommend the use of treatment partners to help people living with HIV adhere to their antiretroviral treatment, there is a need to understand better what makes these partnerships succeed. A recent study conducted in Botswana by researchers from researchers from the Health Unit, RAND Corporation, Santa Monica, Botswana Harvard AIDS Institute Partnership, Gaborone, department of internal medicine, faculty of medicine, University of Botswana and the
Indiana University Network Science Institute, Indiana University
, suggests that individuals whose partners provided more holistic, non-medical support, were more likely to be virally suppressed.

The researchers interviewed 131 adults living with HIV and their treatment partners attending an HIV clinic in Gaborone, Botswana. Participants had been on antiretroviral treatment for at least six months and half (51%) of those selected were virally suppressed.

Participants and their treatment partners were interviewed separately. Wherein they provided details of the nature of their relationship and the characteristics of the HIV-positive person’s social network overall.

The findings suggest people who selected spouses or other intimate partners as treatment partners, and who trusted and felt close to members of their social network as a whole, were more likely to be virally suppressed. This is because a treatment partner who was in a close and trusted relationship with someone living with HIV has more frequent opportunities to observe that person and provide on-hand support to meet a range of needs.

The researchers also found that the treatment partners of people with suppressed HIV tended to provide more in-depth adherence support, such as dropping off medications, as well as broader, non-medical support that encouraged someone to stay healthy in ways not directly tied to medication.

For example, treatment partners of people with suppressed HIV were more likely to prepare food or baths, and proactively attend to other emotional and physical needs. They were also more likely to remind the person to eat healthily, to exercise, to avoid alcohol and drugs, and provide general support and acceptance. Overall, 69% of patients who reported receiving these kinds of nonmedical support from their treatment partner were virally suppressed.

Treatment partners of people with unsuppressed HIV tended to focus more narrowly on reminding people to take medication or attend appointments. Even when providing nonmedical support, treatment partners in this category tended to focus on medication, for example, by reminding someone to eat before taking antiretrovirals.

Citing similar findings from Uganda, researchers suggest the reason why treatment partners who took a more holistic approach were more successful was because they may have been perceived to be more caring, whereas treatment partners with a more-narrow or ‘badgering’ focus on adherence were more likely to be viewed as failing to understand the wider context and challenges experienced by someone living with HIV.

At the moment, people living with HIV are rarely given guidance on who they should select, and likewise treatment partners are often not advised on how to provide effective support.

These findings suggest treatment partners not only need basic, biomedical training about HIV medication, adherence and side effects, but they could also benefit from training about what kinds of support are most effective, how to provide this support through the use of non-confrontational counselling skills, and which approaches to avoid.

Abstract
Objective: Many national HIV guidelines recommend that health care providers encourage patients to identify a treatment partner from their social network to support antiretroviral therapy adherence. This study examined associations of patient and treatment partner characteristics with patient viral suppression in Botswana.
Design: One hundred thirty-one patients [67 (51.1%) virally suppressed and 64 (48.9%) not suppressed] and their treatment partners were recruited for cross-sectional interviews from one HIV clinic.
Methods: Participants completed surveys assessing social network, sociodemographic, and psychosocial characteristics. Open-ended questions explored treatment partner relationship quality.
Results: Multivariate logistic regressions indicated a higher likelihood of viral suppression among patients who reported greater average emotional closeness to their network members [odds ratio (95% confidence interval) = 3.8 (1.3 to 11.5), P = 0.02] and whose treatment partners were spouses/partners [odds ratio (95% confidence interval) = 2.6 (1.0 to 6.7), P = 0.04]. Qualitative analyses indicated that treatment partners of suppressed patients provided both medical and nonmedical support, whereas treatment partners of unsuppressed patients focused mainly on adherence reminders and appointment accompaniment. Treatment partners, especially of unsuppressed patients, requested ongoing training and counseling skills.
Conclusions: Additional research is needed to further explore effective characteristics of treatment partners to inform HIV treatment guidelines. Standard training for treatment partners could include medical-related information and counseling education.

Authors
Bogart, Laura M; Mosepele, Mosepele; Phaladze, Nthabiseng; Lekoko, Bright; Klein, David J; MacCarthy, Sarah; Green, Harold D Jnr

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