Community-Based Accompaniment Mitigates Predictors of Negative Outcomes for Adults on Antiretroviral Therapy in Rural Rwanda.
Clinical, socioeconomic, and access barriers remain a critical problem to antiretroviral (ART) programs in sub-Saharan Africa. Community-based accompaniment (CBA), including daily home visits and psychosocial and socioeconomic support, has been associated with improved patient outcomes at 1 year. We conducted a prospective observational cohort study of 578 HIV-infected adults initiating ART in 2007-2008 with or without CBA in rural Rwanda. Among patients without CBA, those with advanced HIV disease, low CD4 cell counts, lower social support, and transport costs had significantly higher odds of negative outcomes at 1 year; amongst patients who received CBA, only those with low CD4 cell counts had significantly higher odds of negative outcomes at 1 year. CBA also significantly mitigated the effect of transport costs and inaccessibility of services on the likelihood of negative outcome. CBA may be one approach to mitigating known risk factors for negative outcomes for patients on ART in resource-poor settings.
Partners in Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda. ngupta@pih.org.|Division of Global Health Equity, Brigham and Women's Hospital, Boston, USA. ngupta@pih.org.
Neil
N
Gupta
Partners in Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda.|School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.
Christian
C
Munyaburanga
Rwanda Biomedical Center, Kigali, Rwanda.
Mwumvaneza
M
Mutagoma
Partners in Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda.
John W
JW
Niyigena
Ministry of Health, Kigali, Rwanda.
Felix
F
Kayigamba
Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA.
Molly F
MF
Franke
Partners in Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda.|Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA.
Bethany
B
Hedt-Gauthier
D000328:Adult; D000368:Aged; D044966:Anti-Retroviral Agents / Q000008:administration & dosage*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D018791:CD4 Lymphocyte Count; D005260:Female; D006678:HIV / Q000187:drug effects*; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology / Q000821:virology; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D011446:Prospective Studies; D012424:Rural Population; D012432:Rwanda; D012944:Social Support; D016896:Treatment Outcome; D019562:Viral Load
D044966:Anti-Retroviral Agents
Adherence; Antiretroviral therapy; Community-based accompaniment; Rwanda; Virologic suppression