Browsing by Author "Edward J. Mills"

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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
    (2016-10-01) 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
    © 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.