title: Home-based antiretroviral care is associated with positive social outcomes in a prospective cohort in Uganda.
abstract: BACKGROUND
  Home-based antiretroviral therapy (ART) care in Africa has expanded; but social outcomes of home-based ART programs are unknown.
  
  
  METHODS
  Social experiences of participants in an antiretroviral therapy program involving weekly home visits in Uganda were assessed through interviews at enrollment and after 3 months and analyzed using generalized estimating equations.
  
  
  RESULTS
  Of 654 participants, 72% were women; median baseline CD4 cell-count was 123 cells/muL. At follow-up, participants were more likely to report community support (adjusted odds ratio [OR] 2.10, 95% confidence interval [CI]: 1.46 to 3.03, P < 0.001), family support (OR 2.65, CI: 2.01 to 3.49, P < 0.001), and relationship strengthening (OR 2.10, CI: 1.46 to 3.03, P = 0.001) than at baseline; 84% attributed these experiences to antiretroviral therapy program participation. There was no change in incidence of negative experiences (P = 0.3). Forty-six percent of women reported a history of partner abuse, but abuse rates 3 months before and after program initiation were low (1% vs. 2%, OR 3.20, CI: 0.94 to 10.9, P = 0.063). Of five women who reported abuse associated with program participation, all had history of domestic violence. Of all participants reporting outcomes associated with antiretroviral therapy program participation at follow-up, 464 (79%) had only positive experiences, 35 (6%) had both positive and negative experiences, and <1% had only negative experiences.
  
  
  CONCLUSIONS
  Participation in a home-based antiretroviral therapy program was associated with multiple positive social outcomes.
authors.affiliation: CDC-Uganda, Global AIDS Program, Entebbe, Uganda. apondi@UG.CDC.GOV
authors.forename: Rose
authors.initials: R
authors.lastname: Apondi
authors.forename: Rebecca
authors.initials: R
authors.lastname: Bunnell
authors.forename: Anna
authors.initials: A
authors.lastname: Awor
authors.forename: Nafuna
authors.initials: N
authors.lastname: Wamai
authors.forename: Winifred
authors.initials: W
authors.lastname: Bikaako-Kajura
authors.forename: Peter
authors.initials: P
authors.lastname: Solberg
authors.forename: Ron D
authors.initials: RD
authors.lastname: Stall
authors.forename: Alex
authors.initials: A
authors.lastname: Coutinho
authors.forename: Jonathan
authors.initials: J
authors.lastname: Mermin
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy*; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D006699:Home Care Services / Q000458:organization & administration* / Q000706:statistics & numerical data; D006792:House Calls; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D014454:Uganda
chemical_list: D044966:Anti-Retroviral Agents