Task-shifting of antiretroviral delivery from health care workers to persons living with HIV/AIDS: clinical outcomes of a community-based program in Kenya.
OBJECTIVE
To assess whether community-based care delivered by people living with HIV/AIDS (PLWAs) could replace clinic-based HIV care.


METHODS
Prospective cluster randomized controlled clinical trial.


METHODS
Villages surrounding 1 rural clinic in western Kenya.


METHODS
HIV-infected adults clinically stable on antiretroviral therapy (ART).


METHODS
The intervention group received monthly Personal Digital Assistant supported home assessments by PLWAs with clinic appointments every 3 months. The control group received standard of care monthly clinic visits.


METHODS
Viral load, CD4 count, Karnofsky score, stability of ART regimen, opportunistic infections, pregnancies, and number of clinic visits.


RESULTS
After 1 year, there were no significant intervention-control differences with regard to detectable viral load, mean CD4 count, decline in Karnofsky score, change in ART regimen, new opportunistic infection, or pregnancy rate. Intervention patients made half as many clinic visits as did controls (P < 0.001).


CONCLUSIONS
Community-based care by PLWAs resulted in similar clinical outcomes as usual care but with half the number of clinic visits. This pilot study suggests that task-shifting and mobile technologies can deliver safe and effective community-based care to PLWAs, expediting ART rollout and increasing access to treatment while expanding the capacity of health care institutions in resource-constrained environments.
Selke
Henry M
HM
Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
Kimaiyo
Sylvester
S
Sidle
John E
JE
Vedanthan
Rajesh
R
Tierney
William M
WM
Shen
Changyu
C
Denski
Cheryl D
CD
Katschke
Adrian R
AR
Wools-Kaloustian
Kara
K
D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D019058:Community Networks / Q000458:organization & administration*; D055812:Community-Based Participatory Research; D003695:Delivery of Health Care / Q000458:organization & administration*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D007630:Kenya; D008297:Male; D008507:Medically Underserved Area; D010865:Pilot Projects; D016896:Treatment Outcome
D044966:Anti-Retroviral Agents