Authors (including presenting author) :
Chan S, Leung FYC, Chan SN, Fong CY, Au SM, Chan KY, Yiu YH, Ng SK, Li SW, Ho YH, Wong WS, Yeung KY, Tang THC, Kwong TS, Lee MP
Affiliation :
HIV Clinical Service, Department of Medicine, Queen Elizabeth Hospital
Introduction :
With advancement in anti-retroviral therapy (ART), the mortality rate of people with HIV (PWH) has significantly decreased, and their life expectancy is almost similar to that of the general population. ART adherence is crucial for HIV viral suppression so as to achieve U=U (Undetectable = Untransmittable). However, PWH with suboptimal or poor ART adherence who fail to achieve sustained viral suppression, putting them at risk of immunological deterioration and developing of ART resistance. As the HIV Specialty Nurses, monitoring ART adherence is a key component of their role.
Directly Observed Treatment (DOT) has been widely implemented in the management of various diseases, such as tuberculosis, psychiatric illnesses, and has proven effective in improving treatment outcomes. Additionally, HA nurse clinics have been practicing digital measures (i.e. Telehealth) since COVID pandemic and it is currently applied in different HA counterparts. Hence, in March 2024, HIV Specialty Nurses designed a Digital DOT (dDOT) pilot program combining the advantages of both DOT and telemedicine, to address PWH who have drug adherence problem at HIV clinic of Queen Elizabeth Hospital (QEH).
Objectives :
1. To improve ART adherence among non-adherent PWH 2. To improve HIV viral load (VL) suppression of non-adherent PWH.
Methodology :
The dDOT program utilizes Zoom to conduct DOT. A Zoom link was provided by the QEH Information Technology Department after obtaining verbal consent from PWH. dDOT sessions were carried out at a scheduled meeting time daily during clinic office hour and continued for at least four weeks. During the Zoom meeting, PWH took their medication under direct supervision. To protect PWH privacy, discussions of HIV-related issues were prohibited.
Diagram 1: shows the pilot program from planning to implementation
Plan-Do-Check-Act approach: Plan • Recognise the need of patients who have difficulty in adhering to treatment leading to suppressed viral load • Formulate a proposal • Seek support from clinic team members Do • Liaison with KCC IT staff to set up Point-of-care (POC) telehealth at clinic • Create a telehealth message template for HIV clinic • Prepare the equipment & environment Check • Patient selection • Provide information to target patients and check their readiness • Obtain patient’s verbal consent Act • Launch a pilot program
Inclusion criteria:
1. PWH who failed to achieve virologic suppression (HIV VL > 1000 copies/mL) due to suboptimal ART adherence;
2. PWH were on a daily ART regimen;
3. PWH agreed to join dDOT on voluntary basis;
4. PWH knew how to operate the Zoom software.
Result & Outcome :
Results: Outcomes of selected patients for Digital DOT pilot program from March 2024 to March 2025 were reviewed retrospectively. Five patients were selected during the recruitment period. All of their HIV VL before digital DOT were more than 1000 copies/ml. After initiation of digital DOT, four out of five patients’ HIV VL were in decreasing trend. Three out of five patients latest VL were less than 200 copies/ml and two patients achieved viral suppression. One selected patient dropped out digital DOT due to poor WiFi network.
Conclusion: dDOT is effective in helping non-adherent PWH to improve their viral suppression. From planning to implementation, dDOT has demonstrated both technically and logistically feasibility. As a result, HIV Nurse Clinic has formally requested the official launch of telehealth service from HAHO at the end of year 2024. Last but not least, other specialties may also consider applying dDOT to their clinic services according to their own circumstances.
