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Author Maama, Llang Bridget ♦ Howard, Andrea A. ♦ Daftary, Amrita ♦ Saito, Suzue ♦ Gross, Tal ♦ Frederix, Koen ♦ Wu, Yingfeng ♦ Hirschmoverman, Yael
Source Directory of Open Access Journals (DOAJ)
Content type Text
Publisher Taylor & Francis Group
File Format PDF
Date Created 2016-07-13
Copyright Year ©2016
Language English
Subject Domain (in LCC) RA1-1270
Subject Keyword Cost-effectiveness ♦ TB/HIV integration ♦ TB treatment success ♦ Public aspects of medicine ♦ Medicine ♦ Implementation science ♦ Acceptability
Abstract Background: Initiating antiretroviral therapy (ART) early during tuberculosis (TB) treatment increases survival; however, implementation is suboptimal. Implementation science studies are needed to identify interventions to address this evidence-to-program gap. Objective: The Start TB Patients on ART and Retain on Treatment (START) Study is a mixed-methods, cluster-randomized trial aimed at evaluating the effectiveness, cost-effectiveness, and acceptability of a combination intervention package (CIP) to improve early ART initiation, retention, and TB treatment success among TB/HIV patients in Berea District, Lesotho. Design: Twelve health facilities were randomized to receive the CIP or standard of care after stratification by facility type (hospital or health center). The CIP includes nurse training and mentorship, using a clinical algorithm; transport reimbursement and health education by village health workers (VHW) for patients and treatment supporters; and adherence support using text messaging and VHW. Routine data were abstracted for all newly registered TB/HIV patients; anticipated sample size was 1,200 individuals. A measurement cohort of TB/HIV patients initiating ART was recruited; the target enrollment was 384 individuals, each to be followed for the duration of TB treatment (6–9 months). Inclusion criteria were HIV-infected; on TB treatment; initiated ART within 2 months of TB treatment initiation; age ≥18; English- or Sesotho-speaking; and capable of informed consent. The exclusion criterion was multidrug-resistant TB. Three groups of key informants were recruited from intervention clinics: early ART initiators; non/late ART initiators; and health care workers. Primary outcomes include ART initiation, retention, and TB treatment success. Secondary outcomes include time to ART initiation, adherence, change in CD4+ count, sputum smear conversion, cost-effectiveness, and acceptability. Follow-up and data abstraction are complete. Discussion: The START Study evaluates a CIP targeting barriers to early ART implementation among TB/HIV patients. If the CIP is found effective and acceptable, this study has the potential to inform care for TB/HIV patients in high-burden, resource-limited countries in sub-Saharan Africa.
ISSN 16549880
Age Range 18 to 22 years ♦ above 22 year
Educational Use Research
Education Level UG and PG ♦ Career/Technical Study
Learning Resource Type Article
Publisher Date 2016-06-01
e-ISSN 16549880
Journal Global Health Action
Volume Number 9
Page Count 11
Starting Page 1
Ending Page 11


Source: Directory of Open Access Journals (DOAJ)