Pauline Anyango

46 A Combo Pack (Pill Pack, Alarm Clock, and Water Bottle) for improving Antiretroviral Therapy Adherence among Adolescents and Young People Living with HIV Pauline Phiona1,2 1 Hamptons hospital Limited, 2Reducing HIV in Adolescents and Youth (RHAY) Will a combo pack (pill pack, alarm clock and water bottle) improve ARV treatment adherence among adolescents in Kisumu County, Kenya? • Adherence is critical for antiretroviral therapy (ART) treatment success and long-term viral suppression. • Adolescents and young people living with HIV (AYPLWH) face challenges in ART adherence which leads to viral replication, increased risk of HIV transmission, disease progression, drug resistance and preventable HIV-related deaths. • Commonly cited factors of poor adherence include stigma, pill burden and poor medication time keeping. • Promoting strategies such as using alarms, calendars and pillboxes are individually effective in facilitating ART adherence but we do not know their combined effect. • We piloted the use of a combo pack composed of water bottle,pill pack, wrist watch and ankara bag to improve ART adherence among AYPLWH. • We employed a randomized trial design, with improved ART adherence as the primary outcome. • We enrolled AYPLWH aged 15-24 years with documented high viral loads (>1000 copies/ml), enrolled in care in 3 public health facilities in Kisumu County, Kenya. • We randomized half to intervention arm and half to control arm. • Participants in the intervention arm received a combo package consisting of an Ankara print bag with enough space for a water bottle, pills and an alarm clock. • Participants in the control arm received the standard of care from the health facility. Results • We enrolled 202 participants and randomized them 1:1 to two study arms. • Mean age was 17.9 years; 51.5% were females; 96.5% were single; 16.8%, 63.8% and 19.3% had primary, secondary and postsecondary education, respectively. • The proportion of AYPLWH reporting missed clinic visits in the intervention arm declined by 8.0% (49.0% to 41.0% pre-post intervention), compared to the control arm, where the proportion increased by 1.6% (52.9% to 54.5% pre-post intervention). • Forgetfulness, which was cited as the major reason for missing pills, declined in the intervention group by 20.7% c(87.3% to 66.7% prepost intervention) as well as in the control arm by 15.3% (78.1% to 62.8% at follow up). • In terms of pill count, a comparable proportion, 37.0% in the intervention arm and 37.3% in the control arm, achieved good adherence. 80 The proportion reporting missed pills in the intervention group declined by 21.6% (61.0% to 39.4% pre-post intervention), similarly the control group had a decline of 29.9% (71.6% to 41.6% at follow up). 70 60 50 40 Pre Post 30 20 10 0 Intervention Control Fig 3: Missed Pills comparison Bar Graph Fig 1: Combo Pack (Water bottle, Alarm watch, Pill Pack and Water Bottle) Pre-Intervention Post-Intervention Pre-Control Post-Control Regarding VL; participants with VL >300 c/ml declined by 1.0% (10.0% to 9.0% pre-post) in the intervention arm compared to control arm where the proportion declined by 3.9% (3.9% to 7.8% at follow-up). Fig 4: Viral Load comparison Pie Chart Fig 2: Combo Pack (Water bottle, Alarm watch, Pill Pack and Water Bottle) Conclusions and Recommendations • The intervention showed minimal impact on ART adherence when assessed using both pre-post and intervention and control designs. • Further research may be needed to understand factors influencing adherence and to explore additional interventions or modifications to the combo pack to enhance its effectiveness. UNDETECTABLE VIRAL LOAD GOOD ADHERENCE UNTRASMITTABLE