Background: The proportion of people living with HIV (PLHIV) on ART with viral load suppression (VLS) in Central Asia remains low. Historically, nurse engagement in antiretroviral therapy (ART) adherence support was limited to ad-hoc facility-based counseling. In 2018, ICAP launched a structured nurse-led intervention to improve adherence and retention of PLHIV on ART at 9 ART sites across Kazakhstan, Kyrgyzstan, and Tajikistan.
Methods: Thirty-two nurses were trained to provide home-based services to PLHIV. The intervention focused on two adult (>=18 years) PLHIV populations, (1) those newly initiated/restarted on ART and (2) PLHIV on ART six months or more with viral load of 1,000 or more copies/mL. The intervention included up to eight home-visits and nine-twelve phone calls over a six-month period, in addition to the standard of care. ICAP used an online mobile application for program monitoring. Effectiveness of the intervention was assessed by analyzing the proportion of PLHIV with VLS (< 1000 copies/mL), measured at 180(±90) days after the first home visit. Descriptive analysis was conducted using the Chi-Square test.
Results: By December 2018, 1,712 PLHIV (979 men and 733 women) agreed to participate in the program and had at least one home-visit by a nurse. The mean age was 38 years (IQR 31-43). Among them, 111 (6.5%) dropped out of the intervention for various reasons, 846 (49.4%) “graduated” from the intervention, and 755 (44.1%) were still enrolled. Of the 846 PLHIV (455 men and 39 women) who graduated from the program, 699 PLHIV (82.6%, 95%CI 79.9%-85.1%) achieved VLS. VLS outcomes did not differ by sex. PLHIV who newly initiated/restarted ART were more likely to achieve VLS than those who had been on ART six months or more and had unsuppressed viral load at the start of the intervention (93.0% vs 72.8%, p< 0.0001).
Conclusions: This nurse-led, home-based, structured intervention has been effective at ensuring improved ART adherence and high rates of VLS in Central Asia, among both ART-naïve patients and PLHIV on ART with virological failure. The Ministry of Health in Kazakhstan is considering national scale-up of the program and it has the potential to be effectively implemented in other similar settings.

Download the e-Poster