title: Bringing antiretroviral therapy (ART) closer to the end-user through mobile clinics and home-based ART: systematic review shows more evidence on the effectiveness and cost effectiveness is needed.
abstract: BACKGROUND
  Home-based antiretroviral therapy (ART) and ART through mobile clinics can potentially increase access to ART for large numbers of people, including hard-to-reach populations. We reviewed literature on the effectiveness and cost implications of the home-based ART and mobile clinic ART models.
  
  
  METHODS
  We searched Medline, Embase, PsycInfo, CINAHL, Cochrane Library, Web of Knowledge and Current Controlled Trials Register for articles published up to March 2012. We included non-randomised and randomised controlled clinical trials that recruited HIV/AIDS positive adults with or without prior exposure to ART.
  
  
  RESULTS
  Six studies were included in the review, with only four effectiveness studies (all evaluating home-based ART and none for mobile clinic ART) and four studies reporting on the cost implications. The evidence suggests home-based ART is as effective as health facility-based ART, including on clinical outcomes, viral load and CD4+ count. However, three of these studies were very small. Studies suggest health facility-based ART is the most cost-effective, followed by mobile-clinic ART, with home-based ART being the least cost-effective.
  
  
  CONCLUSIONS
  Evidence on the effectiveness and cost implications of mobile clinic and home-based ART is currently limited. Although the few available studies suggest home-based ART can potentially be as effective as health facility-based ART, there is need for more research before robust conclusions can be made. Results from the few available studies also suggest that health facility-based ART is the most cost-effective.
authors.affiliation: Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK.
authors.forename: Noreen Dadirai
authors.initials: ND
authors.lastname: Mdege
authors.affiliation: Autonomous Medical Stores (SAMES), Ministry of Health, Dili, Timor-Leste.
authors.forename: Stanley
authors.initials: S
authors.lastname: Chindove
mesh_terms: D019380:Anti-HIV Agents / Q000191:economics / Q000600:supply & distribution* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D015658:HIV Infections / Q000188:drug therapy; D006699:Home Care Services / Q000191:economics / Q000458:organization & administration; D006801:Humans; D008952:Mobile Health Units / Q000191:economics / Q000458:organization & administration; D015397:Program Evaluation
chemical_list: D019380:Anti-HIV Agents
keywords: HIV/AIDS; antiretroviral therapy; cost effectiveness; effectiveness; home‐based; mobile clinic; service delivery