title: Improving clinic attendance and adherence to antiretroviral therapy through a treatment supporter intervention in Uganda: a randomized controlled trial.
abstract: We assessed the effectiveness of the treatment supporter initiative as an intervention in improving clinic attendance for antiretroviral (ARV) drug refills and adherence to antiretroviral therapy (ART) in a cohort of HIV-infected adults. This two-arm randomized controlled trial was undertaken at an HIV clinic in a district hospital in Uganda. A total of 174 adult patients on ART were randomized 1:1 to a standard adherence intervention package plus a treatment supporter intervention (TS arm) or to a standard adherence intervention package (non-TS arm) alone. Clinic attendance for refills and adherence measurements using monthly clinic-based pill counts were monitored for both arms for 28 weeks. Baseline characteristics were similar for both arms. There was a non-significant difference in mean adherence between the TS and non-TS groups at end of follow-up [99.1% (95% CI: 98.3-99.9% vs. 96.3% (95% CI: 94.2-98.3%), P > 0.05]. TS participants had more than four times the odds of achieving optimal adherence (≥95%) [Odds ratio (OR) = 4.51, 95% CI: 1.22-16.62, exact P = 0.027]. TS participants were also more likely to be on time for their clinic appointments: 91.6 vs. 90.1% for TS and non-TS, respectively (OR = 1.19, 95% CI: 0.74-1.91, P > 0.05). Use of patient-selected treatment supporters may be an effective intervention to improve ARV treatment outcomes in resource-constrained settings.
authors.affiliation: Nuffield Centre for International Health and Development, Institute of Health Sciences, Leeds University, UK. skk31@cantab.net
authors.forename: Setor
authors.initials: S
authors.lastname: Kunutsor
authors.forename: John
authors.initials: J
authors.lastname: Walley
authors.forename: Elly
authors.initials: E
authors.lastname: Katabira
authors.forename: Simon
authors.initials: S
authors.lastname: Muchuro
authors.forename: Hudson
authors.initials: H
authors.lastname: Balidawa
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Namagala
authors.forename: Eric
authors.initials: E
authors.lastname: Ikoona
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000706:statistics & numerical data; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D015497:HIV-1 / Q000187:drug effects*; D006801:Humans; D008297:Male; D009819:Office Visits / Q000706:statistics & numerical data; D010349:Patient Compliance / Q000706:statistics & numerical data*; D012944:Social Support; D016896:Treatment Outcome; D014454:Uganda; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents