Issues: In September 2018, MoH Uganda adopted Dolutegravir (DTG)-based regimens including Tenofovir/Lamivudine/Dolutegravir (TLD) to improve HIV treatment outcomes for eligible patients. A national transition plan was developed to phase in new and phase out legacy ARVs. However, product transitions if not managed well pose a risk of stock outs and wastage through expiries of new and legacy ARVs respectively. We describe Medical Access experience during the roll out of DTG based regimens at PEPFAR/CDC supported health facilities in Uganda.

Description: Orders of new products were obtained from the supply plan and placed with the only two US-FDA approved suppliers for TLD 6 months prior to the transition start date (October 2018). Stock was received in the country 3 months before the transition start date. Product introduction at the health facilities was done in a phased manner with orders adjusted using an order conversion tool that computed the amount of new and legacy ARVs to supply based on patient numbers and the transition rates. Stock availability at the central warehouse and health facilities and patient enrollment numbers were monitored monthly.

Lessons Learned: During the first four months (from October 2018) 54% of 115,012 targeted patients were transitioned to the new optimized regimens and the target was achieved by October 2019 with zero stock outs of TLD. A reduction in consumption of legacy regimens was observed by December 2019: Efavirenz-600mg (76%), Nevirapine-200mg (87%), Zidovudine/Lamivudine/Nevirapine-300mg/150mg/200mg (84%).

Recommendations: Good supply planning and monitoring of product transition processes are key in ensuring successful product introduction.

Introduction:With the advent and use of highly active antiretroviral therapy (HAART), there has been a marked reduction in morbidities and mortalities resulting from the human immunodeficiency virus (HIV) infection. However, little is known about the health-related quality of life (HRQoL) among long-term HAART users. This study sought to systematically examine literature to investigate the potential impact of long-term HAART use on HRQoL.

Methods:Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, five electronic databases (MEDLINE, CINAHL, Cochrane CENTRAL, EMBASE, PsychInfo) were searched from January 1992 for empirical studies which assessed HRQoL outcomes (physical, emotional, mental, vitality, labor productivity).

Results:Preliminary screening of titles/abstracts and full-text articles obtained through literature search yielded 26 studies. Majority of studies reported increased overall HRQoL score for patients using HAART, short-term (a couple of months), when compared to treatment-naïve patients. The HRQoL measures most affected by long-term use of HAART were physical functioning and vitality. Some studies described a deterioration in physical wellbeing and mental health with continued HAART usage despite increased CD4 count, lower viral load, and reduced hospitalizations rates.

Discussion:While clinical results indicate health improvements (high CD4, low viral load) when placed on HAART, overall effect of HAART on HRQoL is a delicate balance between reduced HIV-related morbidities and potential medication side-effects. Competing definitions for “long-term” and “quality of life” for HAART users at various times in their disease trajectories highlight the need for more robust longitudinal studies able to investigate the long-term quality of life impact of HAART use.

Background: The Southeastern US continues to be disproportionately affected by HIV. In 2017, the incidence and prevalence rates in South Carolina were 17 and 399 per 100,000 population, respectively. ART adherence self-efficacy has been shown to be a crucial factor in ART adherence, and hence, attaining and maintaining viral load suppression. How people living with HIV (PLHV) cope with stressors may be associated with ART adherence self-efficacy. However, studies assessing this association are lacking. This study examined different ways of coping and ART adherence self-efficacy among PLHV in South Carolina.

Methods: Cross-sectional data were obtained from 402 PLHV from a large immunology center in South Carolina in 2018. The self-administered behavioral health questionnaire included coping with stressful events and ART self-efficacy. Unadjusted and adjusted multiple linear regression models were used to analyze the association between coping with stressful events (overall coping, alcohol consumption, religiosity, and self-motivation) and ART adherence self-efficacy.

Result: Of the total sample, 43 females (11.14%), 80 males (20.73%), and 114 (28.64%) Black individuals reported ART adherence self-efficacy below the mean (2.7). Alcohol consumption was negatively associated with ART adherence self-efficacy (b=-0.170, 95% CI [-0.255, -0.085], p=0.0001). Religiosity was positively associated with ART adherence self-efficacy (b= 0.101, 95% CI [0.017, 0.185], p= 0.019). Overall coping and self-motivation were not significantly associated with ART adherence self-efficacy.

Conclusion: Accentuating religiosity and attenuating alcohol consumption as a means of coping may improve ART adherence self-efficacy among PLHV. Interventions focused on improving ART adherence self-efficacy may be beneficial, especially for Black PLHV.

Background. Although persons living with HIV (PLWH) are living longer, little is known about factors that contribute to their stopping antiretroviral therapy (ART), what prompts re-starting, and what contributes to sustaining/persisting with ART in times of hardship when risk for discontinuation may be high. We explored these phenomena, focusing on Black and Latinx (BL) PLWH from low SES backgrounds and with serious barriers to ART using a sequential explanatory mixed methods design.

Methods. Participants were BL-PLWH (N=320) with non-suppressed viral load, recruited in New York City. Participants completed a structured assessment battery with reliable/valid measures. A subset (N=41) was randomly selected for in-depth interviews. Bivariate linear regression was used to examine socio-demographic, background, and health-related predictors of 1) rates of stopping/starting ART and 2) the longest period on ART (in months). Qualitative data were analyzed with a systematic content analysis approach, and qualitative and quantitative results were integrated.

Results. Participants were mostly men (72%), Black (70%), 47 years old on average (SD=11 years) and had lived with HIV for an average of 19.7 years (SD=9.1 years). Participants had stopped/started ART an average of 10.3 times (SD=23.5 times). The longest interval of sustained ART was X=38.6 months (SD=48.4 months). Higher rates of stopping/starting ART were associated with being younger, male, transgender, less time living with HIV, more adverse childhood experiences, lifetime homelessness, lower motivation for ART, and moderate-to-high-risk cannabis use. Fewer months of sustained ART use were associated with being Black, higher social support, moderate-to-high-risk alcohol use, and stigma. Qualitative results indicated a convergence of multiple intersecting risk factors for stopping/starting ART and highlighted challenges inherent in managing HIV over decades in the context of poverty. Primary among these was unstable housing, which contributed to social isolation and mental health and substance use problems, which, in turn, often prompted participants to sell ART. Quantitative/qualitative findings were complementary and when taken together described risk factors for stopping ART, protective factors, and the mechanisms by which risk/protective factors operated.

Conclusions. Findings highlight both challenges and strengths inherent in ART persistence and point the way to policy, structural and social-level interventions to support BL-PLWH.