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dc.contributor.authorNachega, JBen
dc.contributor.authorAdetokunboh, Oen
dc.contributor.authorUthman, OAen
dc.contributor.authorKnowlton, AWen
dc.contributor.authorAltice, FLen
dc.contributor.authorSchechter, Men
dc.contributor.authorGalárraga, Oen
dc.contributor.authorGeng, Een
dc.contributor.authorPeltzer, Ken
dc.contributor.authorChang, LWen
dc.contributor.authorVan Cutsem, Gen
dc.contributor.authorJaffar, SSen
dc.contributor.authorFord, Nen
dc.contributor.authorMellins, CAen
dc.contributor.authorRemien, RHen
dc.contributor.authorMills, EJen
dc.date.accessioned2017-02-22T17:34:49Z
dc.date.available2017-02-22T17:34:49Z
dc.date.issued2016-07-30
dc.identifier.citationCommunity-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. 2016: Curr HIV/AIDS Repen
dc.identifier.issn1548-3576
dc.identifier.pmid27475643
dc.identifier.doi10.1007/s11904-016-0325-9
dc.identifier.urihttp://hdl.handle.net/10144/618801
dc.descriptionWe regret that this article is behind a paywall.en
dc.description.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.
dc.languageENG
dc.language.isoenen
dc.publisherSpringer Linken
dc.titleCommunity-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 Targetsen
dc.identifier.journalCurrent HIV/AIDS Reportsen
dc.internal.reviewer-noteCurrent HIV/AIDS Reports - Springeren
refterms.dateFOA2019-03-04T13:11:40Z
html.description.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.


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