Community-Based Interventions to Improve and Sustain Antiretroviral Therapy Adherence, Retention in HIV Care and Clinical Outcomes in Low- and Middle-Income Countries for Achieving the UNAIDS 90-90-90 Targets

Nachega, Jean B.; Adetokunboh, Olatunji; Uthman, Olalekan A.; Knowlton, Amy W.; Altice, Frederick L.; Schechter, Mauro; Galárraga, Omar; Geng, Elvin; Peltzer, Karl; Chang, Larry W.; Van Cutsem, Gilles; Jaffar, Shabbar S.; Ford, Nathan; Mellins, Claude A.; Remien, Robert H.; Mills, Edward J.

doi:10.1007/s11904-016-0325-9

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Community-Based Interventions to Improve and Sustain Antiretroviral Therapy Adherence, Retention in HIV Care and Clinical Outcomes in Low- and Middle-Income Countries for Achieving the UNAIDS 90-90-90 Targets

10 2016
By Nachega, Jean B. ; Adetokunboh, Olatunji ; Uthman, Olalekan A. ; ...
http://dx.doi.org/10.1007/s11904-016-0325-9
Source: Curr HIV/AIDS Rep. 13(5):241-255

[PDF-1.39 MB]

English

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Details:

Alternative Title:

Curr HIV/AIDS Rep
Personal Author:

Nachega, Jean B. ; Adetokunboh, Olatunji ; Uthman, Olalekan A. ; Knowlton, Amy W. ; Altice, Frederick L. ; ... More +

Nachega, Jean B. ; Adetokunboh, Olatunji ; Uthman, Olalekan A. ; Knowlton, Amy W. ; Altice, Frederick L. ; Schechter, Mauro ; Galárraga, Omar ; Geng, Elvin ; Peltzer, Karl ; Chang, Larry W. ; Van Cutsem, Gilles ; Jaffar, Shabbar S. ; Ford, Nathan ; Mellins, Claude A. ; Remien, Robert H. ; Mills, Edward J. Less -
Description:

Little is known about the effect of community versus health facility-based interventions to improve and sustain antiretroviral therapy (ART) adherence, virologic suppression, and retention in care among HIV-infected individuals in low- and middle-income countries (LMICs). We systematically searched four electronic databases for all available randomized controlled trials (RCTs) and comparative cohort studies in LMICs comparing community versus health facility-based interventions. Relative risks (RRs) for pre-defined adherence, treatment engagement (linkage and retention in care), and relevant clinical outcomes were pooled using random effect models. Eleven cohort studies and eleven RCTs (N = 97,657) were included. Meta-analysis of the included RCTs comparing community- versus health facility-based interventions found comparable outcomes in terms of ART adherence (RR = 1.02, 95 % CI 0.99 to 1.04), virologic suppression (RR = 1.00, 95 % CI 0.98 to 1.03), and all-cause mortality (RR = 0.93, 95 % CI 0.73 to 1.18). The result of pooled analysis from the RCTs (RR = 1.03, 95 % CI 1.01 to 1.06) and cohort studies (RR = 1.09, 95 % CI 1.03 to 1.15) found that participants assigned to community-based interventions had statistically significantly higher rates of treatment engagement. Two studies found community-based ART delivery model either cost-saving or cost-effective. Community- versus facility-based models of ART delivery resulted in at least comparable outcomes for clinically stable HIV-infected patients on treatment in LMICs and are likely to be cost-effective.
Subjects:

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Anti-HIV Agents Community Health Centers Cross-Sectional Studies Developing Countries Health Education Health Services Accessibility HIV Infections Humans Medication Adherence Observational Studies As Topic Patient Dropouts Randomized Controlled Trials As Topic Sustained Virologic Response United Nations
Keywords:

[+]

Adherence ART Community Interventions LMIC Retention
Source:

Curr HIV/AIDS Rep. 13(5):241-255
Pubmed ID:

27475643
Pubmed Central ID:

PMC5357578
Document Type:

Journal Article
Funding:

P30 MH062246/MH/NIMH NIH HHSUnited States/ ; UL1 TR001863/TR/NCATS NIH HHSUnited States/ ; U2G GH001536/GH/CGH CDC HHSUnited States/ ; R01 DA013805/DA/NIDA NIH HHSUnited States/ ; PEPFAR/PEPFARUnited States/ ; ... More +

P30 MH062246/MH/NIMH NIH HHSUnited States/ ; UL1 TR001863/TR/NCATS NIH HHSUnited States/ ; U2G GH001536/GH/CGH CDC HHSUnited States/ ; R01 DA013805/DA/NIDA NIH HHSUnited States/ ; PEPFAR/PEPFARUnited States/ ; K24 DA017072/DA/NIDA NIH HHSUnited States/ ; 001/WHO_/World Health OrganizationInternational/ ; UM1 AI069521/AI/NIAID NIH HHSUnited States/ ; WT_/Wellcome TrustUnited Kingdom/ Less -
Collection(s):

CDC Public Access
Main Document Checksum:

[+]

urn:sha256:2ded1b9522c9471ee26c89e143cf75a5ac3bb5bf22e03748f754b8b21af07d05
Download URL:

https://stacks.cdc.gov/view/cdc/44697/cdc_44697_DS1.pdf
File Type:

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