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. 2009 Mar 1;50(3):276-82.
doi: 10.1097/QAI.0b013e3181988375.

Two-year virologic outcomes of an alternative AIDS care model: evaluation of a peer health worker and nurse-staffed community-based program in Uganda

Larry W Chang  1 , Stella Alamo, Samuel Guma, Jason Christopher, Tara Suntoke, Richard Omasete, Jennifer P Montis, Thomas C Quinn, Margrethe Juncker, Steven J Reynolds
Affiliations

Two-year virologic outcomes of an alternative AIDS care model: evaluation of a peer health worker and nurse-staffed community-based program in Uganda

Larry W Chang et al. J Acquir Immune Defic Syndr. .

Abstract

Background: There is growing concern about the human resources needed to care for increasing numbers of patients receiving antiretroviral therapy in resource-limited settings. We evaluated an alternative model, community-based, comprehensive antiretroviral program staffed primarily by peer health workers and nurses.

Methods: We conducted a retrospective cohort study of patients receiving antiretroviral therapy during the first 10 months of program enrollment beginning in late 2003. Virologic, immunologic, clinical, and adherence data were collected.

Results: Of 360 patients started on treatment, 258 (72%) were active and on therapy approximately 2 years later. Viral load testing demonstrated that 86% of active patients (211/246 tested) had a viral load <400 copies per milliliter. The median CD4 increase for active patients was 197 cells per cubic millimeter (interquartile range, 108-346). Patients with either a history of antiretroviral use or lack of CD4 response were more likely to experience virologic failure. Survival was 84% at 1 year and 82% at 2 years. World Health Organization stage 4 was predictive of both not sustaining therapy and increased mortality.

Conclusions: A community-based antiretroviral treatment program in a resource-limited setting can provide excellent AIDS care over at least a 2-year period. A comprehensive program based upon peer health workers and nurses provides an effective alternative model for AIDS care.

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Figures

Figure 1
Figure 1
Profile of Reach Out cohort.
Figure 2
Figure 2
Kaplan-Meier estimate with 95% confidence intervals of the proportion of adults remaining in care and on antiretroviral therapy.
Figure 3
Figure 3
Kaplan-Meier estimate with 95% confidence intervals of the proportion of adults surviving after initiation of antiretroviral therapy.
See this image and copyright information in PMC

References

    1. Van Damme W, Kober K, Laga M. The real challenges for scaling up ART in sub-Saharan Africa. Aids. 2006 Mar 21;20(5):653–656. - PubMed
    1. Colebunders R, Ronald A, Katabira E, Sande M. Rolling out antiretrovirals in Africa: there are still challenges ahead. Clin Infect Dis. 2005 Aug 1;41(3):386–389. - PubMed
    1. Staszewski S, Miller V, Sabin C, et al. Virological response to protease inhibitor therapy in an HIV clinic cohort. Aids. 1999 Feb 25;13(3):367–373. - PubMed
    1. Lucas GM, Chaisson RE, Moore RD. Highly active antiretroviral therapy in a large urban clinic: risk factors for virologic failure and adverse drug reactions. Ann Intern Med. 1999 Jul 20;131(2):81–87. - PubMed
    1. Deeks SG, Hecht FM, Swanson M, et al. HIV RNA and CD4 cell count response to protease inhibitor therapy in an urban AIDS clinic: response to both initial and salvage therapy. Aids. 1999 Apr 16;13(6):F35–43. - PubMed

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