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

SOURCE: Current HIV/AIDS Reports
OUTPUT TYPE: Journal Article
PUBLICATION YEAR: 2016
TITLE AUTHOR(S): J.B.Nachega, O.Adetokunboh, O.A.Uthman, A.W.Knowlton, F.L.Altice, M.Schechter, O.Galarraga, E.Geng, K.Peltzer, L.W.Chang, G.Van Cutsem, S.S.Jaffar, N.Ford, C.A.Mellins, R.H.Remien, E.J.Mills
KEYWORDS: ANTIRETROVIRAL THERAPY, HIV/AIDS, INTERVENTION
DEPARTMENT: Social Aspects of Public Health (SAPH)
Print: HSRC Library: shelf number 9319

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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 lowand 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.