30 April 2013
Community support including home visits by a health worker and directly observed therapy for HIV infection independently lowered chances of death and improved chances of retention in care in rural Rwanda.
Once people begin antiretroviral therapy (ART), major goals become reaching an undetectable viral load and steady retention in care. To address these needs, health workers in Rwanda developed a support program including daily home visits by a community health worker, directly observed therapy, nutritional support, transportation stipends, and other support as needed.
This prospective observational study compared retention, viral load, and mortality in 610 HIV-positive adults starting ART with the support program or with standard facility-based based care. Health workers recorded psychosocial and clinical characteristics for all study participants when they began ART. They assessed mortality, treatment retention, and viral load after 1 year of therapy.
A higher proportion of people in the support program than in standard care (85% versus 79%) remained in care with an undetectable viral load 1 year after starting ART. Statistical analysis that adjusted for CD4 count, depression, physical health quality of life, and food insecurity determined that community-based support lowered the risk of death 83% (hazard ratio 0.17, 95% confidence interval 0.09 to 0.35, P < 0.0001).
A second statistical model determined that people receiving community support were 15% more likely to remain in care with an undetectable viral load than were people receiving standard care (risk ratio 1.15, 95% confidence interval 1.03 to 1.27, P = 0.01).
The researchers conclude that the community-based support program “is effective in improving retention, when added to a clinic-based program with fewer patient support mechanisms.”
Source: Molly F. Franke, Felix Kaigamba, Adrienne R. Socci, Massudi Hakizamungu, Anita Patel, Emmanuel Bagiruwigize, Peter Niyigena, Kelly D. C. Walker, Henry Epino, Agnes Binagwaho, Joia Mukherjee, Paul E. Farmer, Michael L. Rich. Improved retention associated with community-based accompaniment for antiretroviral therapy delivery in rural Rwanda. Clinical Infectious Diseases. 2013; 56: 1319-1326.
For the study abstract
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