Molly F. Franke|Felix Kaigamba|Adrienne Socci|Massudi Hakizamungu|Anita Patel|Emmanuel Bagiruwigize|Peter Niyigena|Kelly D.C. Walker|Henry Epino|Agnès Binagwaho|Joia Mukherjee|Paul Farmer|Michael L. Rich
Improved Retention Associated With Community-Based Accompaniment for Antiretroviral Therapy Delivery in Rural Rwanda
Partners In Health|Harvard Global Health Institute|Harvard University|Ministry of Health|Partners In Health|Partners In Health|Partners In Health|Ministry of Health|Partners In Health|Partners In Health|Brigham and Women's Hospital|Partners In Health|Massachusetts General Hospital|Ministry of Health|Harvard Global Health Institute|Harvard University|Partners In Health|Brigham and Women's Hospital|Harvard Global Health Institute|Harvard University|Brigham and Women's Hospital|Partners In Health|Harvard Global Health Institute|Harvard University|Brigham and Women's Hospital|Partners In Health
minimizing death ensuring high retention good adherence remain ongoing challenges human immunodeficiency virus hiv treatment programs examined whether addition communitybased accompaniment characterized daily home visits community health worker directly observed treatment nutritional support transportation stipends support needed rwanda national model antiretroviral therapy art delivery would improve retention care viral load suppression change cd4 count relative national model alonewe conducted prospective observational cohort study among 610 hivinfected adults initiating art 1 2 programs rural rwanda psychosocial clinical characteristics recorded art initiation death treatment retention plasma viral load assessed 1 year cd4 count evaluated 6month intervals multivariable regression models used adjust baseline differences 2 populationseightyfive percent 79 participants communitybased clinicbased programs respectively retained viral load suppression 1 year adjusting cd4 count depression physical health quality life food insecurity communitybased accompaniment protective death loss followup first year art hazard ratio 017 95 confidence interval ci 0935 p 0001 second multivariable analysis individuals receiving accompaniment likely retained suppressed viral load 1 year risk ratio 115 95 ci 103127 p 01these findings indicate communitybased accompaniment effective improving retention added clinicbased program fewer patient support mechanisms