The impact of a household intervention on art adherence and household HIV competency for people living with HIV: results from a cluster-randomised controlled trial in cape town, South Africa

Abstract

Abstract: In 2023, an estimated 39.9 million people globally were living with HIV, including 7.7 million in South Africa. Adherence to antiretroviral therapy (ART) is crucial for health outcomes, yet remains challenging. Households may shape health behaviours, including ART adherence. This study evaluated a household-level intervention to improve ART adherence in Cape Town, South Africa, which aimed to promote HIV competency for participants and their households. Baseline data were collected from 316 participants in 12 clinics (May 2021 - May 2022), with endline data from 198 participants (December 2021 - July 2022). Cluster-level analysis and mixed-effects models, with multiple imputation and complete case approaches, were utilised. At endline, there was evidence of a difference between control and intervention arms for following the ART schedule (aOR: 3.88, t = 2.62, p = 0.009), and taking ART on time (aOR: 2.28, t = 2.54, p = 0.01). Household-based interventions may have an impact on ART adherence, and should be considered in future adherence research, programming, and interventions.