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.
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.
Authors: Paul J Weidle; Nafuna Wamai; Peter Solberg; Cheryl Liechty; Sam Sendagala; Willy Were; Jonathan Mermin; Kate Buchacz; Prosper Behumbiize; Ray L Ransom; Rebecca Bunnell Journal: Lancet Date: 2006-11-04 Impact factor: 79.321
Authors: David M Moore; Jonathan Mermin; Anna Awor; Benita Yip; Robert S Hogg; Julio S G Montaner Journal: J Acquir Immune Defic Syndr Date: 2006-12-01 Impact factor: 3.731
Authors: Jeffrey S A Stringer; Isaac Zulu; Jens Levy; Elizabeth M Stringer; Albert Mwango; Benjamin H Chi; Vilepe Mtonga; Stewart Reid; Ronald A Cantrell; Marc Bulterys; Michael S Saag; Richard G Marlink; Alwyn Mwinga; Tedd V Ellerbrock; Moses Sinkala Journal: JAMA Date: 2006-08-16 Impact factor: 56.272
Authors: Lisa A Spacek; Hasan M Shihab; Moses R Kamya; Doris Mwesigire; Allan Ronald; Harriet Mayanja; Richard D Moore; Michael Bates; Thomas C Quinn Journal: Clin Infect Dis Date: 2005-12-12 Impact factor: 9.079
Authors: Paula Braitstein; Martin W G Brinkhof; François Dabis; Mauro Schechter; Andrew Boulle; Paolo Miotti; Robin Wood; Christian Laurent; Eduardo Sprinz; Catherine Seyler; David R Bangsberg; Eric Balestre; Jonathan A C Sterne; Margaret May; Matthias Egger Journal: Lancet Date: 2006-03-11 Impact factor: 79.321
Authors: Edwin Wouters; Wim Van Damme; Dingie van Rensburg; Caroline Masquillier; Herman Meulemans Journal: BMC Health Serv Res Date: 2012-07-09 Impact factor: 2.655
Authors: Veronica Escamilla; Carla J Chibwesha; Matthew Gartland; Namwinga Chintu; Mwangelwa Mubiana-Mbewe; Kebby Musokotwane; Patrick Musonda; William C Miller; Jeffrey S A Stringer; Benjamin H Chi Journal: J Acquir Immune Defic Syndr Date: 2015-11-01 Impact factor: 3.731
Authors: Larry W Chang; David Serwadda; Thomas C Quinn; Maria J Wawer; Ronald H Gray; Steven J Reynolds Journal: Lancet Infect Dis Date: 2013-01 Impact factor: 25.071
Authors: Larry W Chang; Veronica Njie-Carr; Sheila Kalenge; Jack F Kelly; Robert C Bollinger; Stella Alamo-Talisuna Journal: AIDS Care Date: 2013-03-01
Authors: Hermann Bussmann; C William Wester; Ndwapi Ndwapi; Nicolas Grundmann; Tendani Gaolathe; John Puvimanasinghe; Ava Avalos; Madisa Mine; Khumo Seipone; Max Essex; Victor Degruttola; Richard G Marlink Journal: AIDS Date: 2008-11-12 Impact factor: 4.177
Authors: 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 Journal: PLoS One Date: 2010-06-02 Impact factor: 3.240
Authors: Carol R Tobias; Serena Rajabiun; Julie Franks; Sarah B Goldenkranz; David N Fine; Brenda S Loscher-Hudson; Paul W Colson; Sharon M Coleman Journal: J Community Health Date: 2010-12
Authors: Tom Decroo; Isabella Panunzi; Carla das Dores; Fernando Maldonado; Marc Biot; Nathan Ford; Kathryn Chu Journal: J Int AIDS Soc Date: 2009-05-06 Impact factor: 5.396