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

Details

• Alternative Title:
  Curr HIV/AIDS Rep
• Personal Author:
  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.
• 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:
  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

  More +
• 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/ ; K24 DA017072/DA/NIDA NIH HHSUnited States/ ; 001/WHO_/World Health OrganizationInternational/ ; UM1 AI069521/AI/NIAID NIH HHSUnited States/ ; WT_/Wellcome TrustUnited Kingdom/
• Volume:
  13
• Issue:
  5
• 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:
  [PDF - 1.39 MB ]