title: Two-year virologic outcomes of an alternative AIDS care model: evaluation of a peer health worker and nurse-staffed community-based program in Uganda.
abstract: BACKGROUND
  There is growing concern about the human resources needed to care for increasing numbers of patients receiving antiretroviral therapy in resource-limited settings. We evaluated an alternative model, community-based, comprehensive antiretroviral program staffed primarily by peer health workers and nurses.
  
  
  METHODS
  We conducted a retrospective cohort study of patients receiving antiretroviral therapy during the first 10 months of program enrollment beginning in late 2003. Virologic, immunologic, clinical, and adherence data were collected.
  
  
  RESULTS
  Of 360 patients started on treatment, 258 (72%) were active and on therapy approximately 2 years later. Viral load testing demonstrated that 86% of active patients (211/246 tested) had a viral load <400 copies per milliliter. The median CD4 increase for active patients was 197 cells per cubic millimeter (interquartile range, 108-346). Patients with either a history of antiretroviral use or lack of CD4 response were more likely to experience virologic failure. Survival was 84% at 1 year and 82% at 2 years. World Health Organization stage 4 was predictive of both not sustaining therapy and increased mortality.
  
  
  CONCLUSIONS
  A community-based antiretroviral treatment program in a resource-limited setting can provide excellent AIDS care over at least a 2-year period. A comprehensive program based upon peer health workers and nurses provides an effective alternative model for AIDS care.
authors.affiliation: Division of Infectious Diseases, Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA. lchang8@jhmi.edu
authors.forename: Larry W
authors.initials: LW
authors.lastname: Chang
authors.forename: Stella
authors.initials: S
authors.lastname: Alamo
authors.forename: Samuel
authors.initials: S
authors.lastname: Guma
authors.forename: Jason
authors.initials: J
authors.lastname: Christopher
authors.forename: Tara
authors.initials: T
authors.lastname: Suntoke
authors.forename: Richard
authors.initials: R
authors.lastname: Omasete
authors.forename: Jennifer P
authors.initials: JP
authors.lastname: Montis
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Quinn
authors.forename: Margrethe
authors.initials: M
authors.lastname: Juncker
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Reynolds
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000009:adverse effects / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D003153:Community Health Services / Q000458:organization & administration* / Q000592:standards; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D008297:Male; D017146:Models, Organizational; D009726:Nurses; D010349:Patient Compliance; D010379:Peer Group; D015397:Program Evaluation; D012189:Retrospective Studies; D014454:Uganda; D019562:Viral Load; D000078329:Workforce
chemical_list: D019380:Anti-HIV Agents