Intervention
ION DEPLETION
For our study intervention, we assigned a mobility coordinator to each clinic who was responsible for intervention delivery. At baseline and during routine clinic visits, the mobility coordinator offered the intervention participants choice of the following options: (1) provision of a “travel pack,” which included an unmarked handbag (for women) or wallet (for men), along with an emergency 14-day supply of ART for abrupt unplanned travel (refilled at clinic visits on depletion), discrete alternative ART packaging options (eg, zip lock bags, envelopes, pill boxes) in an effort to address the stigma associated with carrying pill bottles (a marker of HIV positivity), and a travel checklist to remind participants of essential items to bring when traveling away from home for >1 night, including ART and the mobility coordinator's phone number; (2) inquiries about travel plans at each clinic visit; (3) “hotline” phone and SMS access to the mobility coordinator to discuss travel plans, with encouragement and a welcoming environment for communication of health needs during travel; (4) assistance in obtaining ART refills from out-of-community clinics for participants in need of refills during unexpected travel; (5) longer duration of pill dispensing, with up to 6-month supplies of ART; (6) out-of-facility refills for participants unable to return to clinic; and (7) assistance with transfers from the local clinic to out-of-community HIV clinics when participants out-migrated without a plan to return. Participants with unsuppressed viral load underwent intensive adherence counseling, and those who were suppressed were congratulated and encouraged to continue adhering to treatment. The mobility coordinator worked with clinic dispensaries to obtain antiretroviral medications for the emergency 14-day pill supply (in the travel pack) and longer ART refills for participants planning to travel. The mobility coordinator also worked with HIV service providers to assist with transfers of HIV care for participants who reported plans to out-migrate and requested transfer of care to another clinic.