title: Community-Based Accompaniment and the Impact of Distance for HIV Patients Newly Initiated on Antiretroviral Therapy: Early Outcomes and Clinic Visit Adherence in Rural Rwanda.
abstract: Community-based accompaniment (CBA) has been associated with improved antiretroviral therapy (ART) patient outcomes in Rwanda. In contrast, distance has generally been associated with poor outcomes. However, impact of distance on outcomes under the CBA model is unknown. This retrospective cohort study included 537 adults initiated on ART in 2012 in two rural districts in Rwanda. The primary outcomes at 6 months after ART initiation included overall program status, missed a visit and missed three consecutive visits. The associations between cost surface distance (straight-line distance adjusted for surface features) and outcomes were assessed using logistic regression, controlling for potential confounders. Died/lost-to-follow-up and missed three consecutive visits were not associated with distance. Patients within 0-1 km cost surface distance were significantly more likely to miss a visit, potentially due to stigma of attending clinic within one's community. These results suggest that CBA may mediate the impact of long distances on outcomes.
authors.affiliation: Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda. fabienmuny@gmail.com.|School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda. fabienmuny@gmail.com.
authors.forename: Fabien
authors.initials: F
authors.lastname: Munyaneza
authors.affiliation: School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.
authors.forename: Joseph
authors.initials: J
authors.lastname: Ntaganira
authors.affiliation: School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.
authors.forename: Laetitia
authors.initials: L
authors.lastname: Nyirazinyoye
authors.affiliation: Partners In Health, Boston, MA, USA.
authors.forename: Ermyas
authors.initials: E
authors.lastname: Birru
authors.affiliation: Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda.
authors.forename: Marie Paul
authors.initials: MP
authors.lastname: Nisingizwe
authors.affiliation: Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda.|Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Neil
authors.initials: N
authors.lastname: Gupta
authors.affiliation: Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda.
authors.forename: Cheryl L
authors.initials: CL
authors.lastname: Amoroso
authors.affiliation: Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda.
authors.forename: Guillaine
authors.initials: G
authors.lastname: Neza
authors.affiliation: Partners In Health, Boston, MA, USA.|Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.|Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Lisa R
authors.initials: LR
authors.lastname: Hirschhorn
authors.affiliation: Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda.|School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.|Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
authors.forename: Bethany L
authors.initials: BL
authors.lastname: Hedt-Gauthier
mesh_terms: D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care / Q000523:psychology*; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D044966:Anti-Retroviral Agents / Q000008:administration & dosage*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D003153:Community Health Services / Q000458:organization & administration; D003150:Community Health Workers; D023801:Directly Observed Therapy; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D012111:Residence Characteristics; D012189:Retrospective Studies; D012424:Rural Population; D012432:Rwanda; D057545:Social Stigma; D012944:Social Support; D000074822:Treatment Adherence and Compliance; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents; D044966:Anti-Retroviral Agents
keywords: Antiretroviral therapy; Cost surface distance; Treatment outcomes; Visit adherence