Optimizing Retention in Care and Adherence to Anti-retroviral Therapy Amongst Adolescents Living With HIV in Rwanda
Condition: Human Immunodeficiency Virus
MeSH terms: Acquired Immunodeficiency Syndrome; HIV Infections
Study type: Interventional

Summary: 
      HIV has now become the leading cause of death amongst adolescents in Africa with over 2.1
      million adolescents (aged 10-19 years old) living with HIV today. Poor adherence to
      anti-retroviral therapy (ART) leads to suppressed immune function, treatment failure,
      increased morbidity and mortality with significant costs to households and health systems.

      The investigators aim to undertake a feasibility study of an intervention targeting
      adolescents living with HIV in Rwanda built on two components.

        1. Life-skills training: Adolescents receive training on economic empowerment, financial
           literacy, healthy relationships and adherence during the peer group sessions.

        2. Financial incentives: Combined short-term and long-term incentives for clinic attendance
           and suppressed viral load that will be delivered through mobile banking.
    

Detailed description: 
      HIV has now become the leading cause of death amongst adolescents in Africa with over 2.1
      million adolescents (aged 10-19 years old) living with HIV today. Increased mortality amongst
      HIV-infected adolescents is primarily caused by poor adherence to anti-retroviral therapy
      (ART). Adherence to ART is critical to suppress HIV viral load, sustain immune function, and
      avoid opportunistic infections and death. Poor adherence leads to suppressed immune function,
      treatment failure, increased morbidity and mortality with significant costs to households and
      health systems. In our clinic population in Rwanda, 29% of 12-19 years olds have a
      non-suppressed viral load due to poor adherence. These findings have been reflected in
      studies throughout the US, Europe and sub-Saharan Africa.

      The evidence base for effective adherence interventions that successfully address the
      multiple barriers to adherence is very limited. Conditional cash transfers have shown promise
      as a potential strategy. The investigators aim to undertake a feasibility study of an
      intervention targeting adolescents living with HIV in Rwanda built on two components.

        1. Life-skills training: Adolescents receive training on economic empowerment, financial
           literacy, healthy relationships and adherence during the peer group sessions.

        2. Financial incentives: Combined short-term and long-term incentives for clinic attendance
           and suppressed viral load that will be delivered through mobile banking. On admission to
           the program adolescents are provided with a bank account. The rewards delivered to the
           adolescent are divided into a long-term and short term component. The long-term
           incentive accrues and can only be accessed on graduation from the program. The
           short-term component can be accessed immediately.

      The aim of this preliminary study is not to assess for efficacy of the intervention
      (virological suppression and clinic attendance). This preliminary study aims to assess the
      feasibility of the program and data collection strategy in preparation for a large scale
      multi-center evaluation.
    

Intervention name(s): YBank program
Intervention type(s): Behavioral
Intervention description(s): Adolescents participated in a 12-week peer-led life skills trainings at clinics and received financial incentives via mobile money upon clinic attendance and demonstration of suppressed viral load.
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Supportive Care