Improving RETention and viral load outcomes for people taking Antiretroviral therapy through early IdentificatioN of missed doses (The RETAIn study)

Although advances in antiretroviral therapy (ART) have reduced illness and death for people living with HIV (PLWH), recent evidence highlights gaps in the HIV continuum, including poor adherence and low retention in care, particularly in resource-poor, high-burden African settings.

This highlights the need to address two critical priorities: first, PLWH at risk of treatment failure must be identified more rapidly than current systems allow, before they leave care or develop drug resistance; second, these patients need support to keep them in care at optimal adherence levels.

Through this grant we propose to address both problems by the synergy of two projects: a highly efficient, locally-informed randomised study for which the Senior Fellow has recently been successfully funded through an NIH R01 mechanism, called SUSTAIN, together with this project (RETAIN). Both will be conducted in resource-poor communities in Cape Town, South Africa.

The parent SUSTAIN study will evaluate two improved, but feasible methods of identifying (flagging) those with poor adherence earlier than the current standard of care.The RETAIN study will add an intensive therapeutic monitoring component to those flagged with adherence lapses.

Both studies will contribute to the implementation of an enhanced version of the packaged adherence intervention already in place in antiretroviral clinics.

The study team aims to review the impact of this earlier flagging and adherence intervention both on immediate adherence behaviour and drug concentrations (short and long half-life moieties) (RETAIN); as well as on the longer-term outcome of viral suppression at 12 months (RETAIN) and 24 months (SUSTAIN).

In addition, through the mentorship component of this Fellowship, a Nigerian Trainee Fellow will conduct a pilot study to explore whether a medication adherence app can improve ART retention and adherence in newly diagnosed adolescents living with HIV in Benue state, Nigeria. Both projects support health and well-being for all at all ages, compatible with SDG3.

Thorough the collaboration and teamwork engendered by this Fellowship, the career of four African researchers will be promoted and enhanced: the Senior Fellow, the Trainee Fellow, a PhD student and a Masters student; thus increasing research capacity in Africa.