Peer-reviewed article
Enhancing Adherence to Antiretroviral Therapy Among Adolescents Living With HIV Through Group-Based Therapeutic Approaches in Uganda: Findings From a Pilot Cluster-Randomized Controlled Trial
Samuel Kizito, Proscovia Nabunya, Fred M. Ssewamala ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001A pilot study in Uganda tested whether group therapy could help adolescents with HIV take their antiretroviral medicines regularly. Eighty-nine young people aged 10-14 years received either standard care, family-strengthening group sessions, or cognitive behavioral therapy groups over three months. Both group interventions showed better medicine adherence than standard care, particularly the family-strengthening approach in the later months and cognitive behavioral therapy in the fourth month.
Key points
- Multiple family group intervention showed significantly higher adherence compared to usual care at visit 3 (OR = 4.52) and visit 5 (OR = 3.56)
- Group cognitive behavioral therapy showed significantly higher adherence compared to usual care at visit 4 (OR = 2.69)
- Mean attendance was high for both interventions: 87.7% for G-CBT and 90.2% for MFG sessions
- G-CBT is described as a low-cost alternative to individual therapy suitable for low-resource settings
- Study involved 89 participants from 9 clinics, with 3 lost to follow-up and 1 death during the trial period
Limitations
This is a small pilot study with only 89 participants across 9 clinics, which limits generalizability. The follow-up period was relatively short (4 months post-baseline), so long-term adherence outcomes are unknown.
Abstract
OBJECTIVE: We examine the preliminary impact of group-cognitive behavioral therapy (G-CBT) versus a family-strengthening intervention delivered via multiple family group (MFG) in improving ART adherence among adolescents living with HIV (ALHIV) in Uganda. METHODS: We analyzed data from a pilot cluster-randomized trial (2020-2022) conducted in 9 clinics in Uganda among 89 participants, who were eligible out of the 147 ALHIV screened. Participants were eligible if they were aged 10-14 years, HIV positive, taking ART, and living with a family. Adolescents were randomized, at the clinic level, to receive the usual care (n = 29), MFG (n = 34), or G-CBT (n = 26). The interventions were delivered over 3 months. Overall, the mean percentage attendance for the 10 G-CBT and MFG sessions was 87.7% and 90.2%, respectively. Three ALHIV were lost to follow-up, while 1 child died. Adherence was assessed using pharmacy records collected at baseline and 4 additional pharmacy visits. We used mixed-effects logistic regression analysis to examine the effect of the interventions on ART adherence. RESULTS: We found statistically significant main effects for the intervention, χ2(2) = 7.76, p = .021, time, χ2(2) = 39.67, p < .001, and intervention-time interaction effect χ2(6)= 27.65, p < .001. Pairwise comparisons showed increasing adherence in the MFG group compared to usual care at visit 3 (odds ratio [OR] = 4.52 [1.01-20.11], p = .047) and visit 5 (OR = 3.56 [1.42-8.91], p = .007). Also, compared to usual care, participants who received G-CBT showed higher adherence at visit 4 (OR = 2.69 [1.32-5.50], p = .007). CONCLUSIONS: Our study showed preliminary evidence that G-CBT and MFG might have contributed to improved ART adherence among ALHIV. Moreover, G-CBT is a low-cost alternative to expensive individual therapy, especially in low-resource settings. The results warrant the need for more extensive studies to better understand the role of these interventions in the routine care of ALHIV. The trial is registered at ClinicalTrials.Gov (#NCT04528732).
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- Group-cognitive behavioral therapy (G-CBT) and multiple family group (MFG) therapy sessions delivered over 3 months, compared to usual care
- Population
- Adolescents aged 10-14 years living with HIV and taking antiretroviral therapy, living with a family in Uganda (89 participants; 147 screened)
Key finding
MFG showed statistically significant improvement in adherence versus usual care at visit 3 (OR = 4.52, p = .047) and visit 5 (OR = 3.56, p = .007)
Kizito et al. · Prof. Fred M. Ssewamala (OpenAlex works) · 1 Nov 2023