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

Jean B. Nachega, Olatunji Adetokunboh, Olalekan A. Uthman, Amy W. Knowlton, Frederick L. Altice, Mauro Schechter, Omar Galárraga, Elvin Geng, Karl Peltzer, Larry W. Chang, Gilles Van Cutsem, Shabbar S. Jaffar, Nathan Ford, Claude A. Mellins, Robert H. Remien, Edward J. Mills

Research output: Contribution to journalReview article

Abstract

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.

Original languageEnglish (US)
Pages (from-to)241-255
Number of pages15
JournalCurrent HIV/AIDS reports
Volume13
Issue number5
DOIs
StatePublished - Oct 1 2016

Keywords

  • ART
  • Adherence
  • Community
  • Interventions
  • LMIC
  • Retention

ASJC Scopus subject areas

  • Virology
  • Infectious Diseases

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    Nachega, J. B., Adetokunboh, O., Uthman, O. A., Knowlton, A. W., Altice, F. L., Schechter, M., Galárraga, O., Geng, E., Peltzer, K., Chang, L. W., Van Cutsem, G., Jaffar, S. S., Ford, N., Mellins, C. A., Remien, R. H., & Mills, E. J. (2016). 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. Current HIV/AIDS reports, 13(5), 241-255. https://doi.org/10.1007/s11904-016-0325-9