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

Summary

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.

Conditions

• HIV
• Antiretroviral Therapy

Interventions

OTHER

Routine medical record data collection

The study will collect routine medical record data from the electronic medical record system, other electronic databases, and paper charts.

OTHER

Interviews with service providers

Clinicians and lay staff will be interviewed regarding the ART initiation process.

Sponsors & Collaborators

• Bill and Melinda Gates Foundation

  collaborator OTHER

• University of Witwatersrand, South Africa

  collaborator OTHER

• Clinton Health Access Initiative Inc.

  collaborator OTHER

• Boston University

  lead OTHER

Principal Investigators

• Sydney B Rosen, MPA · BU School of Public Health

Eligibility

Min Age

18 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2020-05-21

Primary Completion

2021-04-30

Completion

2024-12-01

Countries

• Malawi
• South Africa

Study Locations