Survey of Procedures and Resources for Initiating Treatment of HIV in Africa-Malawi

Study Overview
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Brief Summary
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In its 2017 revision of the global guidelines for HIV care and treatment, the World Health Organization (WHO) called for rapid or same-day initiation of antiretroviral treatment (ART) for eligible patients testing positive for HIV. However, to date neither the WHO nor the Malawi Ministry of Health has provided detailed guidance on how to implement this recommendation. In sub-Saharan Africa, where most HIV patients are located, studies continue to document high losses of treatment-eligible patients from care before they receive their first dose of antiretroviral medications (ARVs). Among facility-level reasons for these losses are treatment initiation protocols that require multiple clinic visits and long waiting times before a patient who tests positive for HIV is dispensed an initial supply of medications. There is very little published evidence on the practical details of the process and the extent to which it varies by facility, setting, or country. Without a robust baseline evidence base, it is challenging to identify opportunities for making improvements. The SPRINT (Survey of Procedures and Resources for Initiating Treatment of HIV in Africa) study will begin to develop this evidence base. SPRINT will combine a facility-level description of the standard of care with a retrospective record review of patients who recently initiated ART at the study sites. Data will be collected from 12 health facilities in Malawi. The survey will elicit detailed information about current procedures through structured interviews with clinic staff at the selected health facilities. The record review for a retrospective cohort of patients eligible for ART will estimate actual numbers of clinic visits, services provided, and duration of the steps for treatment initiation from start to finish. SPRINT is expected to identify differences in approaches to treatment initiation and potential opportunities for improvement.

Official Title
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Survey of Procedures and Resources for Initiating Treatment of HIV in Africa: The SPRINT Study in Malawi

Conditions
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HIV, Antiretroviral Therapy

Intervention / Treatment
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* Other: Routine medical record data collection
* Other: Interviews with service providers


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adult patients (at least 18 years old) Tested HIV-positive (or brought proof of positive HIV status) at a study site within the study period (1 July 2018 through 30 June 2019) Exclusion Criteria: Pregnant

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Patients who initiated HIV treatment<br> | Other: Routine medical record data collection<br>* The study will collect routine medical record data from the electronic medical record system, other electronic databases, and paper charts.<br>|
| Service providers at study facilities<br> | Other: Interviews with service providers<br>* Clinicians and lay staff will be interviewed regarding the ART initiation process.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Average numbers of visits required to start ART | Number of health system interactions required between HIV diagnosis and first dispensing of ARVs | Up to 6 months after treatment eligibility determined | 
| Time to ART initiation | Average number of days required between HIV diagnosis and first dispensing | Up to 6 months after treatment eligibility determined | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Proportion of patients who initiate by specified time intervals | Proportion of patients who initiate ART within 0, 7, 14, and 28 days and 3 and 6 months of determination of treatment eligibility | Up to 6 months after treatment eligibility determined |