title: Impact of Patient-Selected Care Buddies on Adherence to HIV Care, Disease Progression, and Conduct of Daily Life Among Pre-antiretroviral HIV-Infected Patients in Rakai, Uganda: A Randomized Controlled Trial.
abstract: BACKGROUND
  Data are limited on effects of household or community support persons ("care buddies") on enrollment into and adherence to pre-antiretroviral HIV care. We assessed the impact of care buddies on adherence to HIV clinic appointments, HIV progression, and conduct of daily life among pre-antiretroviral therapy (pre-ART) HIV-infected individuals in Rakai, Uganda.
  
  
  METHODS
  A total of 1209 HIV-infected pre-ART patients aged ≥15 years were randomized to standard of care (SOC) (n = 604) or patient-selected care buddy (PSCB) (n = 605) and followed at 6 and 12 months. Outcomes were adherence to clinic visits, HIV disease progression, and self-reported conduct of daily life. Incidence and prevalence rate ratios and 95% confidence intervals (CIs) were used to assess outcomes in the intent-to-treat and as-treated analyses.
  
  
  RESULTS
  Baseline characteristics were comparable. In the intent to treat analysis, both arms were comparable with respect to adherence to CD4 monitoring visits [adjusted prevalence risk ratio (adjPRR), 0.98; 95% CI: 0.93 to 1.04; P = 0.529], and ART eligibility (adjPRR, 1.00; 95% CI: 0.77 to 1.31; P = 0.946). Good conduct of daily life was significantly higher in the PSCB than the SOC arm (adjPRR, 1.08; 95% CI: 1.03 to 1.13; P = 0.001). More men (61%) compared with women (30%) selected spouses/partners as buddies (P < 0.0001). Twenty-two percent of PSCB arm participants discontinued use of buddies.
  
  
  CONCLUSIONS
  In pre-ART persons, having care buddies improved the conduct of daily life of the HIV-infected patients but had no effect on HIV disease progression and only limited effect on clinic appointment adherence.
authors.affiliation: *Rakai Health Sciences Program, Kalisizo, Uganda; †School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda; ‡Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD; §Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, MD; ‖Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD; ¶Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; #Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
authors.forename: Gertrude
authors.initials: G
authors.lastname: Nakigozi
authors.forename: Fredrick E
authors.initials: FE
authors.lastname: Makumbi
authors.forename: John B
authors.initials: JB
authors.lastname: Bwanika
authors.forename: Lynn
authors.initials: L
authors.lastname: Atuyambe
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Reynolds
authors.forename: Godfrey
authors.initials: G
authors.lastname: Kigozi
authors.forename: Fred
authors.initials: F
authors.lastname: Nalugoda
authors.forename: Larry W
authors.initials: LW
authors.lastname: Chang
authors.forename: Valerian
authors.initials: V
authors.lastname: Kiggundu
authors.forename: David
authors.initials: D
authors.lastname: Serwadda
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Wawer
authors.forename: Ronald H
authors.initials: RH
authors.lastname: Gray
authors.forename: Moses R
authors.initials: MR
authors.lastname: Kamya
mesh_terms: D000293:Adolescent; D000328:Adult; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000473:pathology / Q000523:psychology*; D006298:Health Services Administration; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology*; D012309:Risk-Taking; D012944:Social Support; D014454:Uganda; D055815:Young Adult