Testing a Long-Term Dynamic Choice Intervention to Improve HIV Treatment Retention and Viral Suppression in Malawi

What this Trial Is About

Repeat and prolonged treatment interruption TI among people living with HIV is a major challenge to controlling the HIV epidemic in eastern and southern Africa, including Malawi. This research aims to evaluate an innovative long-term dynamic choice intervention called CHOICE, designed to support ART clients experiencing TI. The trial compares the CHOICE approach with standard care to see if it improves viral suppression after 12 months of follow-up. The CHOICE intervention offers person-centered counseling combined with ongoing, flexible choices about how clients receive their HIV care services. Participants can choose their ART dispensing intervals 1, 3, or 6 months, locations for ART distribution facility, home, or community, and peer mentorship options. These choices can be adjusted at any visit or by phone during the 24-month study period. The control group receives standard care, which includes 1-3 counseling sessions and routine facility-based services without these dynamic choices. Participants will be followed for 12 months to measure viral suppression, with additional monitoring up to 24 months for repeat treatment interruptions, ART coverage, and safety. The study involves regular assessments including viral load tests and will collect data on barriers and facilitators of care as well as the costs and cost-effectiveness of the intervention. This trial aims to find better ways to provide long-term, personalized support to those at risk of treatment interruption.

Ongoing Dynamic Choice to Address HIV Treatment Interruption in Malawi