title: Antiretroviral treatment for HIV in rural Uganda: two-year treatment outcomes of a prospective health centre/community-based and hospital-based cohort.
abstract: BACKGROUND
  In sub-Saharan Africa, a shortage of trained health professionals and limited geographical access to health facilities present major barriers to the expansion of antiretroviral therapy (ART). We tested the utility of a health centre (HC)/community-based approach in the provision of ART to persons living with HIV in a rural area in western Uganda.
  
  
  METHODS
  The HIV treatment outcomes of the HC/community-based ART program were evaluated and compared with those of an ART program at a best-practice regional hospital. The HC/community-based cohort comprised 185 treatment-naïve patients enrolled in 2006. The hospital cohort comprised of 200 patients enrolled in the same time period. The HC/community-based program involved weekly home visits to patients by community volunteers who were trained to deliver antiretroviral drugs to monitor and support adherence to treatment, and to identify and report adverse reactions and other clinical symptoms. Treatment supporters in the homes also had the responsibility to remind patients to take their drugs regularly. ART treatment outcomes were measured by HIV-1 RNA viral load (VL) after two years of treatment. Adherence was determined through weekly pill counts.
  
  
  RESULTS
  Successful ART treatment outcomes in the HC/community-based cohort were equivalent to those in the hospital-based cohort after two years of treatment in on-treatment analysis (VL≤400 copies/mL, 93.0% vs. 87.3%, p = 0.12), and in intention-to-treat analysis (VL≤400 copies/mL, 64.9% and 62.0%, p = 0.560). In multivariate analysis patients in the HC/community-based cohort were more likely to have virologic suppression compared to hospital-based patients (adjusted OR = 2.47, 95% CI 1.01-6.04).
  
  
  CONCLUSIONS
  Acceptable rates of virologic suppression were achieved using existing rural clinic and community resources in a HC/community-based ART program run by clinical officers and supported by lay volunteers and treatment supporters. The results were equivalent to those of a hospital-based ART program run primarily by doctors.
authors: Department of Public Health Sciences, School of Public Health, University of Alberta, Edmonton, Canada. walter.kipp@ualberta.ca
authors: Walter
authors: W
authors: Kipp
authors: Joseph
authors: J
authors: Konde-Lule
authors: L Duncan
authors: LD
authors: Saunders
authors: Arif
authors: A
authors: Alibhai
authors: Stan
authors: S
authors: Houston
authors: Tom
authors: T
authors: Rubaale
authors: Ambikaipakan
authors: A
authors: Senthilselvan
authors: Joa
authors: J
authors: Okech-Ojony
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D003151:Community Health Centers; D016001:Confidence Intervals; D003710:Demography; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D006761:Hospitals; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D016017:Odds Ratio; D010349:Patient Compliance; D011446:Prospective Studies; D012424:Rural Population; D018401:Sample Size; D013997:Time Factors; D016896:Treatment Outcome; D014454:Uganda; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents