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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
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Nachega, Jean B., Adetokunboh, Olatunji, Uthman, Olalekan A., Knowlton, Amy W. , Geng, Elvin, Peltzer, Karl , Chang, Larry W. , Cutsem, Gilles Van, Jaffar, Shabbar S., Ford, Nathan , Mellins, Claude A., Remien, Robert H. and Mills, Edward (2016) 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. Current HIV/AIDS Reports , 13 (5). pp. 241-255. doi:10.1007/s11904-016-0325-9 ISSN 1548-3568.
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Official URL: http://dx.doi.org/10.1007/s11904-016-0325-9
Abstract
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.
| Item Type: | Journal Article | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| Subjects: | R Medicine > RA Public aspects of medicine | ||||||||
| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School | ||||||||
| Library of Congress Subject Headings (LCSH): | HIV-positive persons -- Treatment, HIV-positive persons -- Medical care , HIV infections —Treatment, AIDS (Disease), Systematic reviews (Medical research) | ||||||||
| Journal or Publication Title: | Current HIV/AIDS Reports | ||||||||
| Publisher: | Springer Healthcare | ||||||||
| ISSN: | 1548-3568 | ||||||||
| Official Date: | October 2016 | ||||||||
| Dates: |
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| Volume: | 13 | ||||||||
| Number: | 5 | ||||||||
| Page Range: | pp. 241-255 | ||||||||
| DOI: | 10.1007/s11904-016-0325-9 | ||||||||
| Status: | Peer Reviewed | ||||||||
| Publication Status: | Published | ||||||||
| Access rights to Published version: | Restricted or Subscription Access | ||||||||
| Date of first compliant deposit: | 1 September 2016 | ||||||||
| Date of first compliant Open Access: | 30 July 2017 |
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