Journal Article > ReviewFull Text
Curr HIV/AIDS Rep. 2016 July 30; Volume 13 (Issue 5); 241-255.; DOI:10.1007/s11904-016-0325-9
Nachega JB, Adetokunboh O, Uthman OA, Knowlton AW, Altice FL, et al.
Curr HIV/AIDS Rep. 2016 July 30; Volume 13 (Issue 5); 241-255.; DOI:10.1007/s11904-016-0325-9
Little 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.
Journal Article > CommentaryFull Text
Curr HIV/AIDS Rep. 2009 October 14; Volume 6 (Issue 4); 201-9.; DOI:https://doi.org/10.1007/s11904-009-0027-7
Mills EJ, Ford NP, Singh SN, Eyawo O
Curr HIV/AIDS Rep. 2009 October 14; Volume 6 (Issue 4); 201-9.; DOI:https://doi.org/10.1007/s11904-009-0027-7
There has been an historic expectation that delivering combination antiretroviral therapy (cART) to populations affected by violent conflict is untenable due to population movement and separation of drug supplies. There is now emerging evidence that cART provision can be successful in these populations. Using examples from Médecins Sans Frontières experience in a variety of African settings and also local nongovernmental organizations' experiences in northern Uganda, we examine novel approaches that have ensured retention in programs and adequate adherence. Emerging guidelines from United Nations bodies now support the expansion of cART in settings of conflict.