Two-year virologic outcomes of an alternative AIDS care model: Evaluation of a peer health worker and nurse-staffed community-based program in uganda

Larry W. Chang, Stella Alamo, Samuel Guma, Jason Christopher, Tara Suntoke, Richard Omasete, Jennifer P. Montis, Thomas C. Quinn, Margrethe Juncker, Steven J. Reynolds

Research output: Contribution to journalArticlepeer-review

51 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)276-282
Number of pages7
JournalJournal of Acquired Immune Deficiency Syndromes
Volume50
Issue number3
DOIs
StatePublished - Mar 2009

Keywords

  • Adherence
  • Africa
  • Antiretroviral treatment
  • Community health services
  • Nurses
  • Program evaluation

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

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