The effect of community-based support services on clinical efficacy and health-related quality of life in HIV/AIDS patients in resource-limited settings in sub-Saharan Africa.
Antiretroviral therapy (ART) for HIV/AIDS in developing countries has been rapidly scaled up through directed public and private resources. Data on the efficacy of ART in developing countries are limited, as are operational research studies to determine the effect of selected nonmedical supportive care services on health outcomes in patients receiving ART. We report here on an investigation of the delivery of medical care combined with community-based supportive services for patients with HIV/AIDS in four resource-limited settings in sub-Saharan Africa, carried out between 2005 and 2007. The clinical and health-related quality of life (HRQOL) efficacy of ART combined with community support services was studied in a cohort of 377 HIV-infected patients followed for 18 months, in community-based clinics through patient interviews, clinical evaluations, and questionnaires. Patients exposed to community-based supportive services experienced a more rapid and greater overall increase in CD4 cell counts than unexposed patients. They also had higher levels of adherence, attributed primarily to exposure to home-based care services. In addition, patients receiving home-based care and/or food support services showed greater improvements in selected health-related QOL indicators. This report discusses the feasibility of effective ART in a large number of patients in resource-limited settings and the added value of concomitant community-based supportive care services.
Kabore
Inoussa
I
Family Health International (FHI), Arlington, Virginia 22031, USA. ikabore@fhi.org
Bloem
Jeanette
J
Etheredge
Gina
G
Obiero
Walter
W
Wanless
Sebastian
S
Doykos
Patricia
P
Ntsekhe
Pearl
P
Mtshali
Nomantshali
N
Afrikaner
Eric
E
Sayed
Rauf
R
Bostwelelo
John
J
Hani
Andiswa
A
Moshabesha
Tiisetso
T
Kalaka
Agnes
A
Mameja
Jerry
J
Zwane
Nompumelelo
N
Shongwe
Nomvuyo
N
Mtshali
Phangisile
P
Mohr
Beryl
B
Smuts
Archie
A
Tiam
Appolinaire
A
D000293:Adolescent; D000328:Adult; D017954:Africa South of the Sahara / Q000453:epidemiology; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D003153:Community Health Services; D003625:Data Collection; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology*; D007722:Health Knowledge, Attitudes, Practice; D006699:Home Care Services; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011203:Poverty; D011788:Quality of Life / Q000523:psychology*; D012944:Social Support; D011795:Surveys and Questionnaires; D055815:Young Adult
D019380:Anti-HIV Agents