Larry W. Chang|Joseph Kagaayi|Gertrude Nakigozi|Victor Ssempijja|Arnold H. Packer|David Serwadda|Thomas C. Quinn|Ronald H. Gray|Robert C. Bollinger|Steven J. Reynolds
Effect of Peer Health Workers on AIDS Care in Rakai, Uganda: A Cluster-Randomized Trial
Johns Hopkins University|Johns Hopkins Medicine|Rakai Health Sciences Program|Rakai Health Sciences Program|Rakai Health Sciences Program|Johns Hopkins University|Rakai Health Sciences Program|National Institute of Allergy and Infectious Diseases|National Institutes of Health|Johns Hopkins University|Johns Hopkins Medicine|Johns Hopkins University|Johns Hopkins University|Johns Hopkins Medicine|National Institute of Allergy and Infectious Diseases|National Institutes of Health|Johns Hopkins University|Johns Hopkins Medicine
human resource limitations challenge delivery antiretroviral therapy art lowresource settings conducted cluster randomized trial assess effect communitybased peer health workers phw aids care adults rakai uganda15 aids clinics randomized 21 receive phw intervention n 10 control n 5 phw tasks included clinic homebased provision counseling clinical adherence art social support primary outcomes adherence cumulative risk virologic failure 400 copiesml secondary outcomes virologic failure 24 week time point 192 weeks art analysis intention treat may 2006 july 2008 1336 patients followed 444 33 patients already art start study significant differences found lack adherence 95 pill count adherence risk ratio rr 055 95 confidence interval ci 023135 100 adherence rr 110 95 ci 094130 cumulative risk virologic failure rr 081 95 ci 061108 shorterterm virologic outcomes 24 week virologic failure rr 093 95 ci 065132 48 week rr 083 95 ci 047148 72 week rr 081 95 ci 044149 however virologic failure rates or96 weeks art significantly decreased intervention arm compared control arm 96 week failure rr 050 95 ci 031081 120 week rr 059 95 ci 022160 144 week rr 039 95 ci 016095 168 week rr 030 95 ci 0097092 192 week rr 0067 95 ci 00065071a phw intervention associated decreased virologic failure rates occurring 96 weeks longer art affect cumulative risk virologic failure adherence measures shorterterm virologic outcomes phws may effective intervention sustain longterm art lowresource settingsclinicaltrialsgov nct00675389