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

Jean B. NachegaOlatunji AdetokunbohOlalekan A. UthmanAmy W. KnowltonFrederick L. AlticeMauro SchechterOmar GalárragaElvin GengKarl PeltzerLarry W. ChangGilles Van CutsemShabbar S. JaffarNathan FordClaude A. MellinsRobert H. RemienEdward J. MillsUniversity of Pittsburgh Graduate School of Public HealthUniversiteit StellenboschJohns Hopkins UniversityWarwick Medical SchoolYale University School of MedicineProjeto Praça OnzeBrown UniversityUniversity of California, San FranciscoMahidol UniversityUniversity of LimpopoHuman Sciences Research Council of South AfricaMédecins Sans FrontièresLiverpool School of Tropical MedicineOrganisation Mondiale de la SanteColumbia University in the City of New YorkNew York State Psychiatric InstitutePrecision Global Health2018-12-112019-03-142018-12-112019-03-142016-10-01Current HIV/AIDS Reports. Vol.13, No.5 (2016), 241-25515483576154835682-s2.0-84979984671https://repository.li.mahidol.ac.th/handle/20.500.14594/40721© 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.Mahidol UniversityImmunology and MicrobiologyMedicineCommunity-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 TargetsReviewSCOPUS10.1007/s11904-016-0325-9