Clinical trial NCT04564209: Information Visualizations to Enhance HIV-related Communication
Official title: Information Visualizations to Facilitate Clinician-patient Communication in HIV Care (Info Viz: HIV)
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: HIV
Communication Research
Keywords: Health literacy
HIV
Infographic
Information-visualization
Clinician-patient communication
Health education
Lead sponsor: University of Colorado, Denver
Sponsor class: OTHER
Collaborators: name: National Institute of Nursing Research (NINR)
First posted: 2020-09-25
Enrollment: 164
Sex: ALL
Minimum age (years): 18
Maximum age (years): 80
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Intervention model description: There is a treatment and a control group at each site.
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief summary: HIV disproportionately affects Latinos who have more infections, faster disease progression, more HIV-related deaths, and slower diagnosis and treatment than their white/majority counterparts. This is a concern across the United States (US) and in developing countries, such as the Dominican Republic (DR). The HIV-related health disparities experienced by Latinos are made worse when those living with HIV have low health literacy and difficulty understanding the information they need to manage their health.

The PI developed a set of images to assist clinicians in providing information to Latino people living with HIV (PLWH). These images have been put into a mobile health app so clinicians can easily access them during clinic visits. The PI has tested her with PLWH in the DR and in New York City. So, the next steps in this research are to ensure the images are relevant and useful to Latinos across the United States (US) and to further assess if, and to what extent, the images can improve health outcomes among PLWH in the US and in the DR. We will therefore, adapt images to Latinos of Mexican origin/descent and then test them to determine if these images help clinicians provide information to patients by conducting a study at clinical sites in the US and in the DR.


Eligibility criteria: Inclusion Criteria:

- Participants must self-identify as Latino, be English or Spanish-speaking, living with HIV with a detectable viral load (\>200 copies/mL) at any point in the past year or have an indication of adherence risk, and planning to receive care at the study site for the next year.

Exclusion Criteria:

* Not meeting inclusion criteria or not having the mental capacity to understand the study or provide informed consent.

Primary outcomes:
measure: Change in CD4 Count Over Time
timeFrame: Baseline, 3-month, 6-month, 9-month
Secondary outcomes:
measure: Change in Viral Load Over Time
timeFrame: Baseline, 3-month, 6-month, 9-month
measure: HIV-related Knowledge Assessment
timeFrame: Baseline, 3-month, 6-month, 9-month
measure: Satisfaction With Provider Scale Score
timeFrame: Baseline, 3-month, 6-month, 9-month
measure: SEMCD Scale Score
timeFrame: Baseline, 3-month, 6-month, 9-month
measure: Simplified Medication Adherence Questionnaire (SMAQ)
timeFrame: Baseline, 3-month, 6-month, 9-month
measure: Health Status Average Score
timeFrame: Baseline, 3-month, 6-month, 9-month
measure: Satisfaction With Clinic
timeFrame: Baseline, 3-, 6-, and 9-months
Other outcomes:
measure: Health Literacy Score: Short Assessment of Health Literacy Spanish & English (SAHL S&E)
timeFrame: Baseline visit only
measure: Health Literacy Score: Newest Vital Sign (NVS)
timeFrame: Baseline visit only
measure: Brief Acculturation Rating Scale for Mexican Americans-II
timeFrame: Baseline visit only
Locations:
city: Denver
country: United States
facility: Denver Health and Hospital Authority
state: Colorado
city: La Romana
country: Dominican Republic
facility: Clínica de Familia La Romana
Study officials:
affiliation: University of Colorado College of Nursing
name: Samantha Stonbraker, PhD, MPH, RN
role: PRINCIPAL_INVESTIGATOR
References:
citation: Henao-Martinez AF, Castillo-Mancilla JR. The Hispanic HIV Epidemic. Curr Infect Dis Rep. 2013 Feb;15(1):46-51. doi: 10.1007/s11908-012-0306-0.
citation: Ochoa SC, Sampalis J. Risk perception and vulnerability to STIs and HIV/AIDS among immigrant Latin-American women in Canada. Cult Health Sex. 2014;16(4):412-25. doi: 10.1080/13691058.2014.884632. Epub 2014 Apr 4.
citation: Goldenberg SM, Strathdee SA, Perez-Rosales MD, Sued O. Mobility and HIV in Central America and Mexico: a critical review. J Immigr Minor Health. 2012 Feb;14(1):48-64. doi: 10.1007/s10903-011-9505-2.
citation: Gonzalez JS, Hendriksen ES, Collins EM, Duran RE, Safren SA. Latinos and HIV/AIDS: examining factors related to disparity and identifying opportunities for psychosocial intervention research. AIDS Behav. 2009 Jun;13(3):582-602. doi: 10.1007/s10461-008-9402-4. Epub 2008 May 23.
citation: Xia Q, Braunstein SL, Wiewel EW, Hadler JL, Torian LV. Persistent Racial Disparities in HIV Infection in the USA: HIV Prevalence Matters. J Racial Ethn Health Disparities. 2017 Feb;4(1):87-93. doi: 10.1007/s40615-015-0205-9. Epub 2016 Jan 8.
citation: Rojas P, Malow R, Ruffin B, Rothe EM, Rosenberg R. The HIV/AIDS Epidemic in the Dominican Republic: Key Contributing Factors. J Int Assoc Physicians AIDS Care (Chic). 2011 Sep-Oct;10(5):306-15. doi: 10.1177/1545109710397770. Epub 2011 Mar 2.
citation: De Boni R, Veloso VG, Grinsztejn B. Epidemiology of HIV in Latin America and the Caribbean. Curr Opin HIV AIDS. 2014 Mar;9(2):192-8. doi: 10.1097/COH.0000000000000031.
citation: Perez-Escamilla R. Acculturation, nutrition, and health disparities in Latinos. Am J Clin Nutr. 2011 May;93(5):1163S-7S. doi: 10.3945/ajcn.110.003467. Epub 2011 Mar 2.
citation: Barreto SM, Miranda JJ, Figueroa JP, Schmidt MI, Munoz S, Kuri-Morales PP, Silva JB Jr. Epidemiology in Latin America and the Caribbean: current situation and challenges. Int J Epidemiol. 2012 Apr;41(2):557-71. doi: 10.1093/ije/dys017. Epub 2012 Mar 9.
citation: Wawrzyniak AJ, Ownby RL, McCoy K, Waldrop-Valverde D. Health literacy: impact on the health of HIV-infected individuals. Curr HIV/AIDS Rep. 2013 Dec;10(4):295-304. doi: 10.1007/s11904-013-0178-4.
citation: Laws MB, Lee Y, Rogers WH, Beach MC, Saha S, Korthuis PT, Sharp V, Cohn J, Moore R, Wilson IB. Provider-patient communication about adherence to anti-retroviral regimens differs by patient race and ethnicity. AIDS Behav. 2014 Jul;18(7):1279-87. doi: 10.1007/s10461-014-0697-z.
citation: Kalichman SC, Rompa D. Functional health literacy is associated with health status and health-related knowledge in people living with HIV-AIDS. J Acquir Immune Defic Syndr. 2000 Dec 1;25(4):337-44. doi: 10.1097/00042560-200012010-00007.
citation: Kalichman SC, Benotsch E, Suarez T, Catz S, Miller J, Rompa D. Health literacy and health-related knowledge among persons living with HIV/AIDS. Am J Prev Med. 2000 May;18(4):325-31. doi: 10.1016/s0749-3797(00)00121-5.
citation: Zhang NJ, Terry A, McHorney CA. Impact of health literacy on medication adherence: a systematic review and meta-analysis. Ann Pharmacother. 2014 Jun;48(6):741-51. doi: 10.1177/1060028014526562. Epub 2014 Mar 11.
citation: Barlow J, Wright C, Sheasby J, Turner A, Hainsworth J. Self-management approaches for people with chronic conditions: a review. Patient Educ Couns. 2002 Oct-Nov;48(2):177-87. doi: 10.1016/s0738-3991(02)00032-0.
citation: Mackey LM, Doody C, Werner EL, Fullen B. Self-Management Skills in Chronic Disease Management: What Role Does Health Literacy Have? Med Decis Making. 2016 Aug;36(6):741-59. doi: 10.1177/0272989X16638330. Epub 2016 Apr 6.
citation: Becerra BJ, Arias D, Becerra MB. Low Health Literacy among Immigrant Hispanics. J Racial Ethn Health Disparities. 2017 Jun;4(3):480-483. doi: 10.1007/s40615-016-0249-5. Epub 2016 Jun 20.
citation: Schulman-Green D, Jaser S, Martin F, Alonzo A, Grey M, McCorkle R, Redeker NS, Reynolds N, Whittemore R. Processes of self-management in chronic illness. J Nurs Scholarsh. 2012 Jun;44(2):136-44. doi: 10.1111/j.1547-5069.2012.01444.x. Epub 2012 May 2.
citation: Rao JK, Anderson LA, Inui TS, Frankel RM. Communication interventions make a difference in conversations between physicians and patients: a systematic review of the evidence. Med Care. 2007 Apr;45(4):340-9. doi: 10.1097/01.mlr.0000254516.04961.d5.
citation: Stonbraker S, Smaldone A, Luft H, Cushman LF, Lerebours Nadal L, Halpern M, Larson E. Associations between health literacy, HIV-related knowledge, and information behavior among persons living with HIV in the Dominican Republic. Public Health Nurs. 2018 May;35(3):166-175. doi: 10.1111/phn.12382. Epub 2017 Dec 29.
citation: Stonbraker S, Befus M, Lerebours Nadal L, Halpern M, Larson E. Factors Associated with Health Information Seeking, Processing, and Use Among HIV Positive Adults in the Dominican Republic. AIDS Behav. 2017 Jun;21(6):1588-1600. doi: 10.1007/s10461-016-1569-5.
citation: Stonbraker S, Larson E. Health-information needs of HIV-positive adults in Latin America and the Caribbean: an integrative review of the literature. AIDS Care. 2016 Oct;28(10):1223-9. doi: 10.1080/09540121.2016.1173645. Epub 2016 Apr 21.
citation: Stonbraker S, Halpern M, Bakken S, Schnall R. Developing Infographics to Facilitate HIV-Related Patient-Provider Communication in a Limited-Resource Setting. Appl Clin Inform. 2019 Aug;10(4):597-609. doi: 10.1055/s-0039-1694001. Epub 2019 Aug 14.
citation: Stonbraker S, Richards S, Halpern M, Bakken S, Schnall R. Priority Topics for Health Education to Support HIV Self-Management in Limited-Resource Settings. J Nurs Scholarsh. 2019 Mar;51(2):168-177. doi: 10.1111/jnu.12448. Epub 2018 Nov 19.
citation: Garcia-Retamero R, Okan Y, Cokely ET. Using visual aids to improve communication of risks about health: a review. ScientificWorldJournal. 2012;2012:562637. doi: 10.1100/2012/562637. Epub 2012 May 2.
citation: Garcia-Retamero R, Dhami MK. Pictures speak louder than numbers: on communicating medical risks to immigrants with limited non-native language proficiency. Health Expect. 2011 Mar;14 Suppl 1(Suppl 1):46-57. doi: 10.1111/j.1369-7625.2011.00670.x.
citation: Houts PS, Doak CC, Doak LG, Loscalzo MJ. The role of pictures in improving health communication: a review of research on attention, comprehension, recall, and adherence. Patient Educ Couns. 2006 May;61(2):173-90. doi: 10.1016/j.pec.2005.05.004. Epub 2005 Aug 24.
citation: Arcia A, Suero-Tejeda N, Bales ME, Merrill JA, Yoon S, Woollen J, Bakken S. Sometimes more is more: iterative participatory design of infographics for engagement of community members with varying levels of health literacy. J Am Med Inform Assoc. 2016 Jan;23(1):174-83. doi: 10.1093/jamia/ocv079. Epub 2015 Jul 13.
citation: Kreuter MW, Lukwago SN, Bucholtz RD, Clark EM, Sanders-Thompson V. Achieving cultural appropriateness in health promotion programs: targeted and tailored approaches. Health Educ Behav. 2003 Apr;30(2):133-46. doi: 10.1177/1090198102251021.
citation: Kreuter MW, Strecher VJ, Glassman B. One size does not fit all: the case for tailoring print materials. Ann Behav Med. 1999 Fall;21(4):276-83. doi: 10.1007/BF02895958.
citation: Fernandez-Rhodes L, Robinson WR, Sotres-Alvarez D, Franceschini N, Castaneda SF, Buelna C, Moncrieft A, Llabre M, Daviglus ML, Qi Q, Agarwal A, Isasi CR, Smokowski P, Gordon-Larsen P, North KE. Accuracy of Self-reported Weight in Hispanic/Latino Adults of the Hispanic Community Health Study/Study of Latinos. Epidemiology. 2017 Nov;28(6):847-853. doi: 10.1097/EDE.0000000000000728.
citation: Dillard PK, Zuniga JA, Holstad MM. An integrative review of the efficacy of motivational interviewing in HIV management. Patient Educ Couns. 2017 Apr;100(4):636-646. doi: 10.1016/j.pec.2016.10.029. Epub 2016 Nov 8.
citation: Mandel JC, Kreda DA, Mandl KD, Kohane IS, Ramoni RB. SMART on FHIR: a standards-based, interoperable apps platform for electronic health records. J Am Med Inform Assoc. 2016 Sep;23(5):899-908. doi: 10.1093/jamia/ocv189. Epub 2016 Feb 17.
citation: Sullivan PS, Purcell DW, Grey JA, Bernstein KT, Gift TL, Wimbly TA, Hall E, Rosenberg ES. Patterns of Racial/Ethnic Disparities and Prevalence in HIV and Syphilis Diagnoses Among Men Who Have Sex With Men, 2016: A Novel Data Visualization. Am J Public Health. 2018 Nov;108(S4):S266-S273. doi: 10.2105/AJPH.2018.304762.
citation: Vega WA, Rodriguez MA, Gruskin E. Health disparities in the Latino population. Epidemiol Rev. 2009;31:99-112. doi: 10.1093/epirev/mxp008. Epub 2009 Aug 27.
citation: Osborn CY, Paasche-Orlow MK, Davis TC, Wolf MS. Health literacy: an overlooked factor in understanding HIV health disparities. Am J Prev Med. 2007 Nov;33(5):374-8. doi: 10.1016/j.amepre.2007.07.022.
citation: Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Crotty K. Low health literacy and health outcomes: an updated systematic review. Ann Intern Med. 2011 Jul 19;155(2):97-107. doi: 10.7326/0003-4819-155-2-201107190-00005.
citation: Iribarren S, Siegel K, Hirshfield S, Olender S, Voss J, Krongold J, Luft H, Schnall R. Self-Management Strategies for Coping with Adverse Symptoms in Persons Living with HIV with HIV Associated Non-AIDS Conditions. AIDS Behav. 2018 Jan;22(1):297-307. doi: 10.1007/s10461-017-1786-6.
citation: Millard T, Elliott J, Girdler S. Self-management education programs for people living with HIV/AIDS: a systematic review. AIDS Patient Care STDS. 2013 Feb;27(2):103-13. doi: 10.1089/apc.2012.0294. Epub 2013 Jan 8.
citation: McMahon T, Ward PR. HIV among immigrants living in high-income countries: a realist review of evidence to guide targeted approaches to behavioural HIV prevention. Syst Rev. 2012 Nov 20;1:56. doi: 10.1186/2046-4053-1-56.
citation: Sauceda JA, Brooks RA, Xavier J, Maiorana A, Georgetti Gomez L, Zamudio-Haas S, Rodriguez-Diaz CE, Cajina A, Myers J. From Theory to Application: A Description of Transnationalism in Culturally-Appropriate HIV Interventions of Outreach, Access, and Retention Among Latino/a Populations. J Immigr Minor Health. 2019 Apr;21(2):332-345. doi: 10.1007/s10903-018-0753-2.
citation: Kasper J, van de Roemer A, Pottgen J, Rahn A, Backhus I, Bay Y, Kopke S, Heesen C. A new graphical format to communicate treatment effects to patients-A web-based randomized controlled trial. Health Expect. 2017 Aug;20(4):797-804. doi: 10.1111/hex.12522. Epub 2016 Dec 16.
citation: Storey D, Seifert-Ahanda K, Andaluz A, Tsoi B, Matsuki JM, Cutler B. What is health communication and how does it affect the HIV/AIDS continuum of care? A brief primer and case study from New York City. J Acquir Immune Defic Syndr. 2014 Aug 15;66 Suppl 3:S241-9. doi: 10.1097/QAI.0000000000000243.
citation: Sorlie V, Lopez RA. When language, health literacy, and miscommunication collide: tremors versus seizures. Fam Med. 2011 Jan;43(1):48-50. No abstract available.
citation: Zolnierek KB, Dimatteo MR. Physician communication and patient adherence to treatment: a meta-analysis. Med Care. 2009 Aug;47(8):826-34. doi: 10.1097/MLR.0b013e31819a5acc.
citation: Mogobe KD, Shaibu S, Matshediso E, Sabone M, Ntsayagae E, Nicholas PK, Portillo CJ, Corless IB, Rose CD, Johnson MO, Webel A, Cuca Y, Rivero-Mendez M, Solis Baez SS, Nokes K, Reyes D, Kemppainen J, Reid P, Sanzero Eller L, Lindgren T, Holzemer WL, Wantland D. Language and Culture in Health Literacy for People Living with HIV: Perspectives of Health Care Providers and Professional Care Team Members. AIDS Res Treat. 2016;2016:5015707. doi: 10.1155/2016/5015707. Epub 2016 Jun 2.
citation: Grodensky CA, Golin CE, Pack AP, Pettifor A, Demers M, Massa C, Kamanga G, McKenna K, Corneli A. Adaptation and delivery of a motivational interviewing-based counseling program for persons acutely infected with HIV in Malawi: Implementation and lessons learned. Patient Educ Couns. 2018 Jun;101(6):1103-1109. doi: 10.1016/j.pec.2018.02.004. Epub 2018 Feb 7.
citation: Beach MC, Laws MB, Rose G, Roter D, Lee Y, Chander G, Woodson T, Moore RD, Rogers W, Wilson IB. Effects of Minimal Versus Intensive Intervention to Enhance Motivational Interviewing in HIV Care. AIDS Behav. 2018 Jan;22(1):276-286. doi: 10.1007/s10461-017-1794-6.
citation: Chang BL, Bakken S, Brown SS, Houston TK, Kreps GL, Kukafka R, Safran C, Stavri PZ. Bridging the digital divide: reaching vulnerable populations. J Am Med Inform Assoc. 2004 Nov-Dec;11(6):448-57. doi: 10.1197/jamia.M1535. Epub 2004 Aug 6.
citation: Levy H, Janke AT, Langa KM. Health literacy and the digital divide among older Americans. J Gen Intern Med. 2015 Mar;30(3):284-9. doi: 10.1007/s11606-014-3069-5. Epub 2014 Nov 12.
citation: Syzdykova A, Malta A, Zolfo M, Diro E, Oliveira JL. Open-Source Electronic Health Record Systems for Low-Resource Settings: Systematic Review. JMIR Med Inform. 2017 Nov 13;5(4):e44. doi: 10.2196/medinform.8131.
citation: Wilson BD, Miller RL. Examining strategies for culturally grounded HIV prevention: a review. AIDS Educ Prev. 2003 Apr;15(2):184-202. doi: 10.1521/aeap.15.3.184.23838.
citation: Lescano CM, Brown LK, Raffaelli M, Lima LA. Cultural factors and family-based HIV prevention intervention for Latino youth. J Pediatr Psychol. 2009 Nov-Dec;34(10):1041-52. doi: 10.1093/jpepsy/jsn146. Epub 2009 Jan 30.
citation: Devieux JG, Malow RM, Jean-Gilles MM, Samuels DM, Deschamps MM, Ascencio M Jr, Jean-Baptiste L, Pape JW. Reducing health disparities through culturally sensitive treatment for HIV+ adults in Haiti. ABNF J. 2004 Nov-Dec;15(6):109-15.
citation: Ramos Z, Alegria M. Cultural adaptation and health literacy refinement of a brief depression intervention for Latinos in a low-resource setting. Cultur Divers Ethnic Minor Psychol. 2014 Apr;20(2):293-301. doi: 10.1037/a0035021. Epub 2014 Mar 3.
citation: Sarkar U, Gourley GI, Lyles CR, Tieu L, Clarity C, Newmark L, Singh K, Bates DW. Usability of Commercially Available Mobile Applications for Diverse Patients. J Gen Intern Med. 2016 Dec;31(12):1417-1426. doi: 10.1007/s11606-016-3771-6. Epub 2016 Jul 14.
citation: Abraido-Lanza AF, Echeverria SE, Florez KR. Latino Immigrants, Acculturation, and Health: Promising New Directions in Research. Annu Rev Public Health. 2016;37:219-36. doi: 10.1146/annurev-publhealth-032315-021545. Epub 2016 Jan 6.
citation: Eisinger RW, Dieffenbach CW, Fauci AS. HIV Viral Load and Transmissibility of HIV Infection: Undetectable Equals Untransmittable. JAMA. 2019 Feb 5;321(5):451-452. doi: 10.1001/jama.2018.21167. No abstract available.
citation: Gearing RE, El-Bassel N, Ghesquiere A, Baldwin S, Gillies J, Ngeow E. Major ingredients of fidelity: a review and scientific guide to improving quality of intervention research implementation. Clin Psychol Rev. 2011 Feb;31(1):79-88. doi: 10.1016/j.cpr.2010.09.007. Epub 2010 Oct 7.
citation: Toren KG, Buskin SE, Dombrowski JC, Cassels SL, Golden MR. Time From HIV Diagnosis to Viral Load Suppression: 2007-2013. Sex Transm Dis. 2016 Jan;43(1):34-40. doi: 10.1097/OLQ.0000000000000376.
citation: Street RL Jr, Makoul G, Arora NK, Epstein RM. How does communication heal? Pathways linking clinician-patient communication to health outcomes. Patient Educ Couns. 2009 Mar;74(3):295-301. doi: 10.1016/j.pec.2008.11.015. Epub 2009 Jan 15.
citation: Lee SY, Stucky BD, Lee JY, Rozier RG, Bender DE. Short Assessment of Health Literacy-Spanish and English: a comparable test of health literacy for Spanish and English speakers. Health Serv Res. 2010 Aug;45(4):1105-20. doi: 10.1111/j.1475-6773.2010.01119.x. Epub 2010 May 24.
citation: Weiss BD, Mays MZ, Martz W, Castro KM, DeWalt DA, Pignone MP, Mockbee J, Hale FA. Quick assessment of literacy in primary care: the newest vital sign. Ann Fam Med. 2005 Nov-Dec;3(6):514-22. doi: 10.1370/afm.405.
citation: Chen WT, Wantland D, Reid P, Corless IB, Eller LS, Iipinge S, Holzemer WL, Nokes K, Sefcik E, Rivero-Mendez M, Voss J, Nicholas P, Phillips JC, Brion JM, Rose CD, Portillo CJ, Kirksey K, Sullivan KM, Johnson MO, Tyer-Viola L, Webel AR. Engagement with Health Care Providers Affects Self- Efficacy, Self-Esteem, Medication Adherence and Quality of Life in People Living with HIV. J AIDS Clin Res. 2013 Nov 1;4(11):256. doi: 10.4172/2155-6113.1000256.
citation: Ritter PL, Lorig K. The English and Spanish Self-Efficacy to Manage Chronic Disease Scale measures were validated using multiple studies. J Clin Epidemiol. 2014 Nov;67(11):1265-73. doi: 10.1016/j.jclinepi.2014.06.009. Epub 2014 Aug 3.
citation: Knobel H, Alonso J, Casado JL, Collazos J, Gonzalez J, Ruiz I, Kindelan JM, Carmona A, Juega J, Ocampo A; GEEMA Study Group. Validation of a simplified medication adherence questionnaire in a large cohort of HIV-infected patients: the GEEMA Study. AIDS. 2002 Mar 8;16(4):605-13. doi: 10.1097/00002030-200203080-00012.
citation: Monroe AK, Pena JS, Moore RD, Riekert KA, Eakin MN, Kripalani S, Chander G. Randomized controlled trial of a pictorial aid intervention for medication adherence among HIV-positive patients with comorbid diabetes or hypertension. AIDS Care. 2018 Feb;30(2):199-206. doi: 10.1080/09540121.2017.1360993. Epub 2017 Aug 10.
citation: Penn AW, Azman H, Horvath H, Taylor KD, Hickey MD, Rajan J, Negussie EK, Doherty M, Rutherford GW. Supportive interventions to improve retention on ART in people with HIV in low- and middle-income countries: A systematic review. PLoS One. 2018 Dec 14;13(12):e0208814. doi: 10.1371/journal.pone.0208814. eCollection 2018.