title: Effectiveness of patient adherence groups as a model of care for stable patients on antiretroviral therapy in Khayelitsha, Cape Town, South Africa.
abstract: BACKGROUND
  Innovative models of care are required to cope with the ever-increasing number of patients on antiretroviral therapy in the most affected countries. This study, in Khayelitsha, South Africa, evaluates the effectiveness of a group-based model of care run predominantly by non-clinical staff in retaining patients in care and maintaining adherence.
  
  
  RESULTS
  Participation in "adherence clubs" was offered to adults who had been on ART for at least 18 months, had a current CD4 count >200 cells/ml and were virologically suppressed. Embedded in an ongoing cohort study, we compared loss to care and virologic rebound in patients receiving the intervention with patients attending routine nurse-led care from November 2007 to February 2011. We used inverse probability weighting to estimate the intention-to-treat effect of adherence club participation, adjusted for measured baseline and time-varying confounders. The principal outcome was the combination of death or loss to follow-up. The secondary outcome was virologic rebound in patients who were virologically suppressed at study entry. Of 2829 patients on ART for >18 months with a CD4 count above 200 cells/µl, 502 accepted club participation. At the end of the study, 97% of club patients remained in care compared with 85% of other patients. In adjusted analyses club participation reduced loss-to-care by 57% (hazard ratio [HR] 0.43, 95% CI = 0.21-0.91) and virologic rebound in patients who were initially suppressed by 67% (HR 0.33, 95% CI = 0.16-0.67).
  
  
  CONCLUSIONS
  Patient adherence groups were found to be an effective model for improving retention and documented virologic suppression for stable patients in long term ART care. Out-of-clinic group-based models facilitated by non-clinical staff are a promising approach to assist in the long-term management of people on ART in high burden low or middle-income settings.
authors: Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa. miguel.luquefernandez@uct.ac.za
authors: Miguel Angel
authors: MA
authors: Luque-Fernandez
authors: Gilles
authors: G
authors: Van Cutsem
authors: Eric
authors: E
authors: Goemaere
authors: Katherine
authors: K
authors: Hilderbrand
authors: Michael
authors: M
authors: Schomaker
authors: Nompumelelo
authors: N
authors: Mantangana
authors: Shaheed
authors: S
authors: Mathee
authors: Vuyiseka
authors: V
authors: Dubula
authors: Nathan
authors: N
authors: Ford
authors: Miguel A
authors: MA
authors: Hernán
authors: Andrew
authors: A
authors: Boulle
mesh_terms: D000328:Adult; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D003695:Delivery of Health Care / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D010349:Patient Compliance / Q000706:statistics & numerical data*; D012008:Recurrence; D013019:South Africa; D019562:Viral Load; D055815:Young Adult