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Community-based plus clinical care improved retention for HIV patients in Rwanda
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Community-based accompaniment improved retention when added to a clinic-based program for treating patients with HIV in Rwanda, data from a recent study suggest.
“High rates of retention and viral load suppression are achievable in resource-limited countries, so we as implementers should set the bar high,” Molly Franke, ScD, of the department of global health and social medicine at Harvard Medical School, told Infectious Disease News. “Models of ART delivery that include programmatic elements to facilitate good adherence and ensure high quality care, such as community-based accompaniment, will improve individual health outcomes and could potentially slow the emergence of drug-resistant HIV strains while preserving the effectiveness of first-line regimens.”
Franke and colleagues with Partners in Health in Rwanda conducted a prospective observational cohort study of 610 adults with HIV who were initiating ART treatment in rural Rwanda. All patients received standard clinical care. Half of the patients also received community-based accompaniment, which includes daily visits from a community health worker and other social support.
Among those who had the community-based accompaniment, 85% were retained with viral load suppression at 1 year, compared with 79% of those who were only in the clinic-based program. The researchers then adjusted for CD4 count, depression, social support score, physical health quality of life and travel time to the clinic. They found that those who received the community-based accompaniment were more likely to be retained with a suppressed viral load at 1 year (RR=1.15; 95% CI, 1.03-1.27).
Those who had community-based accompaniment also had a greater increase in CD4 counts after 1 year, but this was not significant after adjustment.
“Supporting patients and maintaining high quality of care as programs age and expand is a key challenge faced by HIV programs,” Franke said. “Resources must be made available to strengthen existing programs that are not achieving high rates of retention and viral load suppression. Successful HIV delivery models will undoubtedly vary across settings, but community-based accompaniment is an example of a successful strategy that could be considered to improve HIV-related outcomes.”
Disclosure: Franke reports no relevant financial disclosures.
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