Impact of patient-selected care buddies on adherence to HIV care, disease progression, and conduct of daily life among pre-antiretroviral HIV-infected patients in Rakai, Uganda: A randomized controlled trial

Gertrude Nakigozi, Fredrick E. Makumbi, John B. Bwanika, Lynn Atuyambe, Steven J. Reynolds, Godfrey Kigozi, Fred Nalugoda, Larry W. Chang, Valerian Kiggundu, David Serwadda, Maria J. Wawer, Ronald H. Gray, Moses R. Kamya

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Data are limited on effects of household or community support persons ("care buddies") on enrollment into and adherence to pre-antiretroviral HIV care. We assessed the impact of care buddies on adherence to HIV clinic appointments, HIV progression, and conduct of daily life among pre-antiretroviral therapy (pre-ART) HIV-infected individuals in Rakai, Uganda. Methods: A total of 1209 HIV-infected pre-ART patients aged ≥15 years were randomized to standard of care (SOC) (n 604) or patient-selected care buddy (PSCB) (n 605) and followed at 6 and 12 months. Outcomes were adherence to clinic visits, HIV disease progression, and self-reported conduct of daily life. Incidence and prevalence rate ratios and 95% confidence intervals (CIs) were used to assess outcomes in the intent-to-treat and as-treated analyses. Results: Baseline characteristics were comparable. In the intent to treat analysis, both arms were comparable with respect to adherence to CD4 monitoring visits [adjusted prevalence risk ratio (adjPRR), 0.98; 95% CI: 0.93 to 1.04; P 0.529], and ART eligibility (adjPRR, 1.00; 95% CI: 0.77 to 1.31; P 0.946). Good conduct of daily life was significantly higher in the PSCB than the SOC arm (adjPRR, 1.08; 95% CI: 1.03 to 1.13; P 0.001). More men (61%) compared with women (30%) selected spouses/partners as buddies (P < 0.0001). Twenty-two percent of PSCB arm participants discontinued use of buddies. Conclusions: In pre-ART persons, having care buddies improved the conduct of daily life of the HIV-infected patients but had no effect on HIV disease progression and only limited effect on clinic appointment adherence.

Original languageEnglish (US)
Pages (from-to)75-82
Number of pages8
JournalJournal of acquired immune deficiency syndromes
Volume70
Issue number1
DOIs
StatePublished - Sep 1 2015

Keywords

  • HIV
  • Uganda
  • patient-selected care buddy
  • pre-ART
  • randomized controlled trial

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

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