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Effectiveness of a combination strategy for linkage and retention in adult HIV care in Swaziland: The Link4Health cluster randomized trial

Author

Listed:
  • Margaret L McNairy
  • Matthew R Lamb
  • Averie B Gachuhi
  • Harriet Nuwagaba-Biribonwoha
  • Sean Burke
  • Sikhathele Mazibuko
  • Velephi Okello
  • Peter Ehrenkranz
  • Ruben Sahabo
  • Wafaa M El-Sadr

Abstract

Background: Gaps in the HIV care continuum contribute to poor health outcomes and increase HIV transmission. A combination of interventions targeting multiple steps in the continuum is needed to achieve the full beneficial impact of HIV treatment. Methods and findings: Link4Health, a cluster-randomized controlled trial, evaluated the effectiveness of a combination intervention strategy (CIS) versus the standard of care (SOC) on the primary outcome of linkage to care within 1 month plus retention in care at 12 months after HIV-positive testing. Ten clusters of HIV clinics in Swaziland were randomized 1:1 to CIS versus SOC. The CIS included point-of-care CD4+ testing at the time of an HIV-positive test, accelerated antiretroviral therapy (ART) initiation for treatment-eligible participants, mobile phone appointment reminders, health educational packages, and noncash financial incentives. Secondary outcomes included each component of the primary outcome, mean time to linkage, assessment for ART eligibility, ART initiation and time to ART initiation, viral suppression defined as HIV-1 RNA

Suggested Citation

  • Margaret L McNairy & Matthew R Lamb & Averie B Gachuhi & Harriet Nuwagaba-Biribonwoha & Sean Burke & Sikhathele Mazibuko & Velephi Okello & Peter Ehrenkranz & Ruben Sahabo & Wafaa M El-Sadr, 2017. "Effectiveness of a combination strategy for linkage and retention in adult HIV care in Swaziland: The Link4Health cluster randomized trial," PLOS Medicine, Public Library of Science, vol. 14(11), pages 1-20, November.
    • Handle: RePEc:plo:pmed00:1002420
    DOI: 10.1371/journal.pmed.1002420
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    Cited by:

    1. Elizabeth R Stevens & Lingfeng Li & Kimberly A Nucifora & Qinlian Zhou & Margaret L McNairy & Averie Gachuhi & Matthew R Lamb & Harriet Nuwagaba-Biribonwoha & Ruben Sahabo & Velephi Okello & Wafaa M E, 2018. "Cost-effectiveness of a combination strategy to enhance the HIV care continuum in Swaziland: Link4Health," PLOS ONE, Public Library of Science, vol. 13(9), pages 1-17, September.
    2. Inghels, Maxime & Kim, Hae-Young & Mathenjwa, Thulile & Shahmanesh, Maryam & Seeley, Janet & Wyke, Sally & McGrath, Nuala & Sartorius, Benn & Yapa, H. Manisha & Dobra, Adrian & Bärnighausen, Till & Ta, 2022. "Can a conditional financial incentive (CFI) reduce socio-demographic inequalities in home-based HIV testing uptake? A secondary analysis of the HITS clinical trial intervention in rural South Africa," Social Science & Medicine, Elsevier, vol. 311(C).

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