Computer-based counseling program (CARE+ Kenya) to promote prevention and HIV health for people living with HIV/AIDS: a randomized controlled trial

Abstract

In countries experiencing the dual burden of human immunodeficiency virus (HIV) disease and health care worker shortages, information and communication technology tools offer a potential solution to help support HIV treatment adherence and secondary HIV transmission risk reduction for people living with HIV/AIDS. We conducted a randomized controlled trial (September 1, 2011 – July 12, 2012) with follow-up through April 2013. Participants were recruited from two clinics affiliated with the Academic Model Providing Access to Healthcare program in western Kenya. A total of 236 participants were enrolled, randomly assigned to intervention (n=118) or risk-assessment only control (n=118) and followed up for 9 months; with 95.3% retention. Both arms had > 0.5 log10 reduction in viral load over time (p=0.0007), a clinically relevant finding. A computer-based counseling tool is feasible and acceptable to implement in a high-volume East African HIV setting and provides evidence-based ART adherence and risk reduction support that may extend health workforce deficits.