title: Community-based accompaniment and psychosocial health outcomes in HIV-infected adults in Rwanda: a prospective study.
abstract: We examined whether the addition of community-based accompaniment to Rwanda's national model for antiretroviral treatment (ART) was associated with greater improvements in patients' psychosocial health outcomes during the first year of therapy. We enrolled 610 HIV-infected adults with CD4 cell counts under 350 cells/μL initiating ART in one of two programs. Both programs provided ART and required patients to identify a treatment buddy per national protocols. Patients in one program additionally received nutritional and socioeconomic supplements, and daily home-visits by a community health worker ("accompagnateur") who provided social support and directly-observed ingestion of medication. The addition of community-based accompaniment was associated with an additional 44.3 % reduction in prevalence of depression, more than twice the gains in perceived physical and mental health quality of life, and increased perceived social support in the first year of treatment. Community-based accompaniment may represent an important intervention in HIV-infected populations with prevalent mental health morbidity.
authors: Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, 4th Floor, Boston, MA, 02115, USA, dana_thomson@hms.harvard.edu.
authors: Dana R
authors: DR
authors: Thomson
authors: Michael L
authors: ML
authors: Rich
authors: Felix
authors: F
authors: Kaigamba
authors: Adrienne R
authors: AR
authors: Socci
authors: Massudi
authors: M
authors: Hakizamungu
authors: Emmanuel
authors: E
authors: Bagiruwigize
authors: Agnes
authors: A
authors: Binagwaho
authors: Molly F
authors: MF
authors: Franke
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D003153:Community Health Services / Q000458:organization & administration; D003150:Community Health Workers; D003863:Depression / Q000453:epidemiology; D023801:Directly Observed Therapy; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012044:Regression Analysis; D012111:Residence Characteristics; D012424:Rural Population; D012432:Rwanda / Q000453:epidemiology; D012944:Social Support; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents