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 James Reynolds, Godfrey Kigozi, Fred Nalugoda, Larry Chang, Valerian Kiggundu, David Serwadda, Maria J Wawer, Ronald H Gray, Moses R. Kamya

Research output: Contribution to journalArticle

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

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Uganda
Disease Progression
Patient Care
Randomized Controlled Trials
HIV
Standard of Care
Confidence Intervals
Odds Ratio
Appointments and Schedules
Ambulatory Care
Spouses
Therapeutics
Incidence

Keywords

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

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

Cite this

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

In: Journal of Acquired Immune Deficiency Syndromes, Vol. 70, No. 1, 01.09.2015, p. 75-82.

Research output: Contribution to journalArticle

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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.",
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T2 - A randomized controlled trial

AU - Nakigozi, Gertrude

AU - Makumbi, Fredrick E.

AU - Bwanika, John B.

AU - Atuyambe, Lynn

AU - Reynolds, Steven James

AU - Kigozi, Godfrey

AU - Nalugoda, Fred

AU - Chang, Larry

AU - Kiggundu, Valerian

AU - Serwadda, David

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AU - Gray, Ronald H

AU - Kamya, Moses R.

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