Musa Manganye, Director of HIV/AIDS Treatment, Care and Support at the National Department of Health in South Africa, writes:
Clients’ healthcare experiences in the first months after initiating antiretroviral therapy (ART) set the tone for the rest of their lifelong ART journey and impact related health outcomes, including viral suppression. While using optimized ART regimens is a crucial component of achieving viral suppression, factors related to service delivery play an important role in ensuring continued engagement.
To enhance support for clients in their first year on ART, South Africa made important service delivery updates in the “2023 ART Clinical Guidelines for the Management of HIV in Adults, Pregnancy and Breastfeeding, Adolescents, Children, Infants and Neonates”.
The guidelines mark an important shift whereby the first viral load (VL) is taken after three months on treatment, which is possible now that clients are initiating dolutegravir (DTG)-containing regimens. This helps reduce unnecessary facility visits early on for people who are virally suppressed and enables earlier support for people struggling with adherence. From month four, virally suppressed clients receive, at a minimum, three-month multi-month dispensing (3MMD) at the facility. They are eligible for South Africa’s DSD models, known as repeat prescription collection strategies.
These new measures are an important contribution to improving the health of people living with HIV and moving South Africa closer to attaining our second and third 95 HIV targets.
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DSD research in action
Understanding early disengagement and treatment interruptions – the Retain6 study
By Sydney Rosen, Mhairi Maskew, Linda Sande, Aniset Kamanga and the Retain6 Project Team
The early treatment period, commonly defined as the first six months after starting or restarting ART, is marked by high rates of disengagement from HIV care.
Boston University’s Department of Global Health, the Health Economics and Epidemiology Research Office (HE2RO) in South Africa and the Clinton Health Access Initiative (CHAI) in Zambia launched the three-year Retain6 project in 2021 to learn more about patterns of and reasons for early disengagement and treatment interruptions and to test new models of service delivery that can improve early outcomes.
The following are some key findings, which were presented at Retain6 workshops in South Africa and Zambia in November 2023:
- Most clients were not ART-naïve: In both countries, most clients who present for ART initiation have treatment experience. Knowledge of this is important to improve care and manage the national programme.
- The treatment cascade is cyclical: Treatment interruptions and a “cyclical” pattern of coming in and out of care are common, especially in the early treatment period.
- There is a need for increased and/or improved counselling and information:
