title: Excellent clinical outcomes and high retention in care among adults in a community-based HIV treatment program in rural Rwanda.
abstract: BACKGROUND
  Access to antiretroviral therapy (ART) has rapidly expanded; as of the end of 2010, an estimated 6.6 million people are receiving ART in low-income and middle-income countries. Few reports have focused on the experiences of rural health centers or the use of community health workers. We report clinical and programatic outcomes at 24 months for a cohort of patients enrolled in a community-based ART program in southeastern Rwanda under collaboration between Partners In Health and the Rwandan Ministry of Health.
  
  
  RESULTS
  A retrospective medical record review was performed for a cohort of 1041 HIV+ adult patients initiating community-based ART between June 1, 2005, and April 30, 2006. Key programatic elements included free ART with direct observation by community health worker, tuberculosis screening and treatment, nutritional support, a transportation allowance, and social support. Among 1041 patients who initiated community-based ART, 961 (92.3%) were retained in care, 52 (5%) died and 28 (2.7%) were lost to follow-up. Median CD4 T-cell count increase was 336 cells per microliter [interquartile range: (IQR): 212-493] from median 190 cells per microliter (IQR: 116-270) at initiation.
  
  
  CONCLUSIONS
  A program of intensive community-based treatment support for ART in rural Rwanda had excellent outcomes in 24-month retention in care. Having committed to improving access to HIV treatment in sub-Saharan Africa, the international community, including country HIV programs, should set high programmatic outcome benchmarks.
authors.affiliation: Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Rich
authors.forename: Ann C
authors.initials: AC
authors.lastname: Miller
authors.forename: Peter
authors.initials: P
authors.lastname: Niyigena
authors.forename: Molly F
authors.initials: MF
authors.lastname: Franke
authors.forename: Jean Bosco
authors.initials: JB
authors.lastname: Niyonzima
authors.forename: Adrienne
authors.initials: A
authors.lastname: Socci
authors.forename: Peter C
authors.initials: PC
authors.lastname: Drobac
authors.forename: Massudi
authors.initials: M
authors.lastname: Hakizamungu
authors.forename: Alishya
authors.initials: A
authors.lastname: Mayfield
authors.forename: Robert
authors.initials: R
authors.lastname: Ruhayisha
authors.forename: Henry
authors.initials: H
authors.lastname: Epino
authors.forename: Sara
authors.initials: S
authors.lastname: Stulac
authors.forename: Corrado
authors.initials: C
authors.lastname: Cancedda
authors.forename: Adolph
authors.initials: A
authors.lastname: Karamaga
authors.forename: Saleh
authors.initials: S
authors.lastname: Niyonzima
authors.forename: Chase
authors.initials: C
authors.lastname: Yarbrough
authors.forename: Julia
authors.initials: J
authors.lastname: Fleming
authors.forename: Cheryl
authors.initials: C
authors.lastname: Amoroso
authors.forename: Joia
authors.initials: J
authors.lastname: Mukherjee
authors.forename: Megan
authors.initials: M
authors.lastname: Murray
authors.forename: Paul
authors.initials: P
authors.lastname: Farmer
authors.forename: Agnes
authors.initials: A
authors.lastname: Binagwaho
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005260:Female; D006678:HIV / Q000235:genetics / Q000302:isolation & purification*; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D010352:Patient Dropouts; D012367:RNA, Viral / Q000097:blood; D012189:Retrospective Studies; D012424:Rural Population; D012432:Rwanda; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents; D012367:RNA, Viral