title: An observational cohort comparison of facilitators of retention in care and adherence to anti-eetroviral therapy at an HIV treatment center in Kenya.
abstract: BACKGROUND
  Most HIV treatment programs in resource-limited settings utilize multiple facilitators of adherence and retention in care but there is little data on the efficacy of these methods. We performed an observational cohort analysis of a treatment program in Kenya to assess which program components promote adherence and retention in HIV care in East Africa.
  
  
  METHODS
  Patients initiating ART at A.I.C. Kijabe Hospital were prospectively enrolled in an observational study. Kijabe has an intensive program to promote adherence and retention in care during the first 6 months of ART that incorporates the following facilitators: home visits by community health workers, community based support groups, pharmacy counseling, and unannounced pill counts by clinicians. The primary endpoint was time to treatment failure, defined as a detectable HIV-1 viral load; discontinuation of ART; death; or loss to follow-up. Time to treatment failure for each facilitator was calculated using Kaplan-Meier analysis. The relative effects of the facilitators were determined by the Cox Proportional Hazards Model.
  
  
  RESULTS
  301 patients were enrolled. Time to treatment failure was longer in patients participating in support groups (448 days vs. 337 days, P<0.001), pharmacy counseling (480 days vs. 386 days, P = 0.002), pill counts (482 days vs. 189 days, P<0.001) and home visits (485 days vs. 426 days, P = 0.024). Better adherence was seen with support groups (89% vs. 82%, P = 0.05) and pill counts (89% vs. 75%, P = 0.02). Multivariate analysis using the Cox Model found significant reductions in risk of treatment failure associated with pill counts (HR = 0.19, P<0.001) and support groups (HR = 0.43, P = 0.003).
  
  
  CONCLUSIONS
  Unannounced pill counts by the clinician and community based support groups were associated with better long term treatment success and with better adherence.
authors.affiliation: AIC Kijabe Hospital, Kijabe, Kenya.
authors.forename: Loice
authors.initials: L
authors.lastname: Achieng
authors.forename: Helen
authors.initials: H
authors.lastname: Musangi
authors.forename: Sharon
authors.initials: S
authors.lastname: Ong'uti
authors.forename: Edwin
authors.initials: E
authors.lastname: Ombegoh
authors.forename: Leeann
authors.initials: L
authors.lastname: Bryant
authors.forename: Jonathan
authors.initials: J
authors.lastname: Mwiindi
authors.forename: Nathaniel
authors.initials: N
authors.lastname: Smith
authors.forename: Philip
authors.initials: P
authors.lastname: Keiser
mesh_terms: D023241:Antiretroviral Therapy, Highly Active / Q000706:statistics & numerical data*; D015331:Cohort Studies; D037001:Directive Counseling / Q000706:statistics & numerical data; D015658:HIV Infections / Q000188:drug therapy*; D006792:House Calls / Q000706:statistics & numerical data; D006801:Humans; D007630:Kenya; D054539:Medication Therapy Management; D019370:Observation; D012657:Self-Help Groups / Q000706:statistics & numerical data; D016903:Drug Monitoring