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

Post Date: 
2016-07-30
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Countries: 
Publication: 
Current HIV/AIDS Reports
Summary: 

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.

Citation: 
Nachega JB, Adetokunboh O, Uthman OA, Knowlton AW, Altice FL, Schechter M, Galárraga O, Geng E, Peltzer K, Chang LW, Van Cutsem G, Jaffar SS, Ford N, Mellins CA, Remien RH, Mills EJ. 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. Curr HIV/AIDS Rep. 2016 Oct;13(5):241-55. doi: 10.1007/s11904-016-0325-9. PMID: 27475643 PMCID: PMC5357578
Collaborators: 


  • University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA

  • Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa

  • Warwick Medical School, The University of Warwick, Coventry, UK

  • Yale University School of Medicine and Public Health, New Haven, CT

  • Projeto Praça Onze, Rio de Janeiro, Brazil

  • Brown University School of Public Health, Providence, RI

  • University of California, San Francisco, CA

  • Mahidol University, Salaya, Thailand

  • University of Limpopo, Polokwane, South Africa

  • Human Sciences Research Council, Pretoria, South Africa

  • Médecins Sans Frontières, Cape Town, South Africa

  • Liverpool School of Tropical Medicine, Liverpool, UK

  • World Health Organization, Geneva, Switzerland

  • HIV Center for Clinical and Behavioral Studies, Columbia University, New York, NY, USA

  • New York State Psychiatric Institute, New York, NY, USA

  • Precision Global Health, Vancouver, Canada