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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Improved retention associated with community-based accompaniment for antiretroviral therapy delivery in rural Rwanda
Clinical Infectious Diseases, Volume 56, No. 9, Year 2013
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Description
Background. Minimizing death and ensuring high retention and good adherence remain ongoing challenges for human immunodeficiency virus (HIV) treatment programs. We examined whether the addition of community-based accompaniment (characterized by daily home visits from a community health worker, directly observed treatment, nutritional support, transportation stipends, and other support as needed) to the Rwanda national model for antiretroviral therapy (ART) delivery would improve retention in care, viral load suppression, and change in CD4 count, relative to the national model alone.Methods. We conducted a prospective observational cohort study among 610 HIV-infected adults initiating ART in 1 of 2 programs in rural Rwanda. Psychosocial and clinical characteristics were recorded at ART initiation. Death, treatment retention, and plasma viral load were assessed at 1 year. CD4 count was evaluated at 6-month intervals. Multivariable regression models were used to adjust for baseline differences between the 2 populations.Results. Eighty-five percent and 79% of participants in the community-based and clinic-based programs, respectively, were retained with viral load suppression at 1 year. After adjusting for CD4 count, depression, physical health quality of life, and food insecurity, community-based accompaniment was protective against death or loss to follow-up during the first year of ART (hazard ratio, 0.17; 95% confidence interval [CI],. 09-.35; P <. 0001). In a second multivariable analysis, individuals receiving accompaniment were more likely to be retained with a suppressed viral load at 1 year (risk ratio: 1.15; 95% CI, 1.03-1.27; P =. 01).Conclusions. These findings indicate that community-based accompaniment is effective in improving retention, when added to a clinic-based program with fewer patient support mechanisms. © 2012 The Author.
Authors & Co-Authors
Franke, Molly F.
United States, Boston
Harvard Medical School
United States, Boston
Partners in Health
Kaigamba, Felix
Rwanda, Kigali
Ruhengeri Hospital
Socci, Adrienne R.
United States, Boston
Partners in Health
Hakizamungu, Massudi
United States, Boston
Partners in Health
Patel, Anita
United States, Boston
Partners in Health
Bagiruwigize, Emmanuel
Rwanda, Kigali
Ruhengeri Hospital
Niyigena, Peter
United States, Boston
Partners in Health
Walker, Kelly D.C.
United States, Boston
Partners in Health
Epino, Henry M.
United States, Boston
Partners in Health
United Kingdom, Brigham
Brigham and Women's Hospital
United States, Boston
Massachusetts General Hospital
Binagwaho, Agnès
United States, Boston
Harvard Medical School
Rwanda, Kigali
Ministry of Health of Rwanda
Mukherjee, Joia S.
United States, Boston
Harvard Medical School
United States, Boston
Partners in Health
United Kingdom, Brigham
Brigham and Women's Hospital
Farmer, Paul E.
United States, Boston
Harvard Medical School
United States, Boston
Partners in Health
United Kingdom, Brigham
Brigham and Women's Hospital
Rich, Michael Leonard
United States, Boston
Partners in Health
United Kingdom, Brigham
Brigham and Women's Hospital
Statistics
Citations: 154
Authors: 13
Affiliations: 6
Identifiers
Doi:
10.1093/cid/cis1193
ISSN:
10584838
e-ISSN:
15376591
Research Areas
Disability
Environmental
Food Security
Health System And Policy
Infectious Diseases
Mental Health
Study Design
Cohort Study
Study Approach
Quantitative
Study Locations
Rwanda