The effect of electronic monitoring devices for adherence support on the risk of virological failure in young people with HIV in Zimbabwe: an open label, randomised controlled trial

Résumé fourni par la source

Background Viral suppression is poorer among young people with HIV (YPWH) than other age groups. We evaluated an electronic monitoring device (EMD) with text message reminders and monthly adherence feedback to improve viral suppression among YPWH in Zimbabwe. Methods YPWH aged 16–30 years taking ART for ≥6 months, with HIV viral load (VL) > 200 copies/ml were randomised 1:1 to receive either a six-month intervention (real-time EMD monitoring, text message reminders triggered if the EMD was not opened within 30 min of the scheduled ART intake time, and monthly EMD-informed adherence feedback), or enhanced adherence counselling. The primary outcome was proportion with VL < 50 copies/ml at six months. Secondary outcomes were proportion with VL < 50copies/ml at nine months, VL rebound (VL ≥ 50copies/ml) at nine months among participants suppressed at six months, and number of ART regimen switches. Findings Between September 2023 and April 2024, 205 participants (102 intervention; mean age 22.6 years SD (3.8); 52% female) were enrolled. Median baseline VL was 12,700 copies/ml (IQR 1020–105,686); 69.8% were taking dolutegravir-based ART. At six months, viral suppression was higher in the intervention than control arm (51.5% vs 36.1%; adjusted risk ratio 1.39, 95% CI 1.01–1.91; p=0.04). No significant differences were observed at nine months, in viral rebound or ART regimen switches. Among 137 participants with genotypic resistance data, resistance to atazanavir-was higher than to dolutegravir (32.6% vs 19.5%). Interpretation An EMD-supported adherence intervention improved short-term viral suppression, but benefits were not sustained after withdrawal, highlighting the need for ongoing adherence support. Funding This study was supported under the capacity strengthening scheme of the VITALITY trial. VITALITY is funded by the EDCTP2 programme supported by the European Union. The genotypic resistance testing data reported in this publication was also supported by the Hamish Ogston Foundation Platinum Jubilee Grants for Early Career Research Professionals awarded to NVD. Preparation of the revised manuscript was supported by the SOFAR Fellowship, which is part of the EDCTP3 programme supported by the European Union.

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