Please use this identifier to cite or link to this item:
Title: 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
Authors: Jean B. Nachega
Olatunji Adetokunboh
Olalekan A. Uthman
Amy W. Knowlton
Frederick L. Altice
Mauro Schechter
Omar Galárraga
Elvin Geng
Karl Peltzer
Larry W. Chang
Gilles Van Cutsem
Shabbar S. Jaffar
Nathan Ford
Claude A. Mellins
Robert H. Remien
Edward J. Mills
University of Pittsburgh Graduate School of Public Health
Universiteit Stellenbosch
Johns Hopkins University
Warwick Medical School
Yale University School of Medicine
Projeto Praça Onze
Brown University
University of California, San Francisco
Mahidol University
University of Limpopo
Human Sciences Research Council of South Africa
Médecins Sans Frontières
Liverpool School of Tropical Medicine
Organisation Mondiale de la Sante
Columbia University in the City of New York
New York State Psychiatric Institute
Precision Global Health
Keywords: Immunology and Microbiology;Medicine
Issue Date: 1-Oct-2016
Citation: Current HIV/AIDS Reports. Vol.13, No.5 (2016), 241-255
Abstract: © 2016, Springer Science+Business Media New York. 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.
ISSN: 15483576
Appears in Collections:Scopus 2016-2017

Files in This Item:
There are no files associated with this item.

Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.