Two-year virologic outcomes of an alternative AIDS care model: evaluation of a peer health worker and nurse-staffed community-based program in Uganda.
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.
Chang
Larry W
LW
Division of Infectious Diseases, Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA. lchang8@jhmi.edu
Alamo
Stella
S
Guma
Samuel
S
Christopher
Jason
J
Suntoke
Tara
T
Omasete
Richard
R
Montis
Jennifer P
JP
Quinn
Thomas C
TC
Juncker
Margrethe
M
Reynolds
Steven J
SJ
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
D019380:Anti-HIV Agents