Community-Based Interventions to Improve and Sustain Antiretroviral Therapy Adherence, Retention in HIV Care and Clinical Outcomes in Low- and Middle-Income Countries for Achieving the UNAIDS 90-90-90 Targets
Van Cutsem, G
MetadataShow full item record
JournalCurrent HIV/AIDS Reports
AbstractLittle is known about the effect of community versus health facility-based interventions to improve and sustain antiretroviral therapy (ART) adherence, virologic suppression, and retention in care among HIV-infected individuals in low- and middle-income countries (LMICs). We systematically searched four electronic databases for all available randomized controlled trials (RCTs) and comparative cohort studies in LMICs comparing community versus health facility-based interventions. Relative risks (RRs) for pre-defined adherence, treatment engagement (linkage and retention in care), and relevant clinical outcomes were pooled using random effect models. Eleven cohort studies and eleven RCTs (N = 97,657) were included. Meta-analysis of the included RCTs comparing community- versus health facility-based interventions found comparable outcomes in terms of ART adherence (RR = 1.02, 95 % CI 0.99 to 1.04), virologic suppression (RR = 1.00, 95 % CI 0.98 to 1.03), and all-cause mortality (RR = 0.93, 95 % CI 0.73 to 1.18). The result of pooled analysis from the RCTs (RR = 1.03, 95 % CI 1.01 to 1.06) and cohort studies (RR = 1.09, 95 % CI 1.03 to 1.15) found that participants assigned to community-based interventions had statistically significantly higher rates of treatment engagement. Two studies found community-based ART delivery model either cost-saving or cost-effective. Community- versus facility-based models of ART delivery resulted in at least comparable outcomes for clinically stable HIV-infected patients on treatment in LMICs and are likely to be cost-effective.
DescriptionWe regret that this article is behind a paywall.
- Decentralising HIV treatment in lower- and middle-income countries.
- Authors: Kredo T, Ford N, Adeniyi FB, Garner P
- Issue date: 2013 Jun 27
- Factors associated with adherence to antiretroviral therapy among adolescents living with HIV/AIDS in low- and middle-income countries: a systematic review.
- Authors: Hudelson C, Cluver L
- Issue date: 2015
- Service delivery interventions to improve adolescents' linkage, retention and adherence to antiretroviral therapy and HIV care.
- Authors: MacPherson P, Munthali C, Ferguson J, Armstrong A, Kranzer K, Ferrand RA, Ross DA
- Issue date: 2015 Aug
- Supportive interventions to improve retention on ART in people with HIV in low- and middle-income countries: A systematic review.
- Authors: Penn AW, Azman H, Horvath H, Taylor KD, Hickey MD, Rajan J, Negussie EK, Doherty M, Rutherford GW
- Issue date: 2018
- Associations Between Anxiety and Adherence to Antiretroviral Medications in Low- and Middle-Income Countries: A Systematic Review and Meta-analysis.
- Authors: Wykowski J, Kemp CG, Velloza J, Rao D, Drain PK
- Issue date: 2019 Aug