A Urine Tenofovir Point‐of‐Care Assay Facilitates Positive Antiretroviral Therapy Adherence Discussions Among People Living With HIV and Healthcare Providers—A Mixed‐Methods Evaluation in Cape Town, South Africa
Abenathi Mcinziba, Dillon T. Wademan, Lario Viljoen, Hanlie Myburgh, Lauren Jennings, Zukiswa Nkantsu, Marije van Schalkwyk, Eric Decloedt, Monica Gandhi, Catherine Orrell, Gert van Zyl, Graeme HoddinottABSTRACT
Introduction
In South Africa, antiretroviral therapy adherence monitoring relies on self‐reported adherence, which is prone to recall error, and only verified annually during blood viral load measurement. A novel urine tenofovir rapid assay (UTRA) is a low‐cost point‐of‐care adherence support tool for people living with HIV (PLHIV). Nested in an effectiveness randomized trial, we aimed to understand the relative acceptability of adherence support experiences among PLHIV receiving the UTRA point‐of‐care adherence intervention versus standard of care.
Methods
All trial participants ( n = 199) completed a brief, repeat‐measures, quantitative acceptability questionnaire at months 3, 6 and 12. We also conducted longitudinal in‐depth interviews with 25 PLHIV with three interactions per participant over 52 weeks—a total of 75 interviews. Interviewed PLHIV were purposively sampled for balance by arm, diversity in age and gender, rich‐case sampling, and saturation. We also conducted once‐off in‐depth interviews with five healthcare providers administering the UTRA intervention. Data were collected between May 2022 and June 2024. Qualitative data analysis involved descriptive summaries of key emergent themes with illustrative case examples augmented by descriptive statistics from the questionnaires.
Results
Participants in the intervention arm reported that being tested and informed about their adherence levels in real‐time served as a reminder to take treatment consistently. The UTRA facilitated conversations between PLHIV and healthcare providers on how to overcome barriers to adherence. Participants in the control arm reported that they relied on relatives for adherence support and accountability because there is limited time for adherence discussions with healthcare providers. Healthcare providers reported that providing adherence counselling to PLHIV receiving standard of care was challenging because they relied on voluntary disclosure of adherence interruptions. PLHIV in the intervention arm reported more positive experiences of adherence support compared to those in the control arm, regardless of their adherence practices.
Conclusions
A point‐of‐care adherence tool like the UTRA provides a much‐needed platform for PLHIV and healthcare providers to discuss adherence practices and challenges. PLHIV preferred this style of adherence support compared to the standard of care.