title: Effects of an HIV-Care-Program on immunological parameters in HIV-positive patients in Yaoundé, Cameroon: a cluster-randomized trial.
abstract: OBJECTIVE
  To measure the effects of an HIV-Care-Program, focusing on nutrition and lifestyle, which can be provided at scale to HIV-infected patients, on clinical and anthropometrical parameters, and health status.
  
  
  METHODS
  A cluster-randomized trial, including 5 health facilities randomized to intervention n = 100 (HIV-Care-Program) or control n = 101 (Usual-Care). The HIV-Care-Program consisted of counseling lessons for 6 months, on: nutrition, hygiene, coping with stigma and discrimination, embedded in practical activities. Outcome variables were CD4 count after 6 months and time to antiretroviral therapy (ARV) initiation, using analysis of covariance and Kaplan-Meier method, respectively.
  
  
  RESULTS
  After 6 months, CD4 count dropped by 46.3 cells (7.7%) (intervention) and 129 (23%) (control) (p = 0.003). Mean time to ARV; 5.9 months 95% CI (5.9, 6.0) (intervention); 4.9 months 95% CI (4.7, 5.2) (control) (p < 0.004). There was a partial correlation between CD4 count and initial viral load (r = -0.190, p = 0.017).
  
  
  CONCLUSIONS
  The intervention provides a low-cost alternative improving health status, slowing down CD4 cell decline, delaying initiation of ARV and thus freeing local ARV capacities for patients in urgent need.
authors.affiliation: Institute for Social Medicine, Epidemiology and Health Economics, Charité, Universitätsmedizin Berlin Center, Berlin, Germany, mbonguegermaine@yahoo.com.
authors.forename: Germaine N
authors.initials: GN
authors.lastname: Nkengfack
authors.forename: Judith N
authors.initials: JN
authors.lastname: Torimiro
authors.forename: Jeanne
authors.initials: J
authors.lastname: Ngogang
authors.forename: Sylvia
authors.initials: S
authors.lastname: Binting
authors.forename: Stephanie
authors.initials: S
authors.lastname: Roll
authors.forename: Peter
authors.initials: P
authors.lastname: Tinnemann
authors.forename: Heike
authors.initials: H
authors.lastname: Englert
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D002163:Cameroon; D003376:Counseling / Q000458:organization & administration*; D004032:Diet; D015444:Exercise; D005260:Female; D015658:HIV Infections / Q000276:immunology / Q000523:psychology / Q000628:therapy*; D006293:Health Promotion / Q000458:organization & administration*; D006302:Health Services Research; D006304:Health Status; D006801:Humans; D006920:Hygiene; D008297:Male; D011287:Prejudice; D057545:Social Stigma; D012959:Socioeconomic Factors; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents