Community-Based Accompaniment Mitigates Predictors of Negative Outcomes for Adults on Antiretroviral Therapy in Rural Rwanda

AIDS and Behavior
Neil GuptaBethany Hedt-Gauthier

Abstract

Clinical, socioeconomic, and access barriers remain a critical problem to antiretroviral (ART) programs in sub-Saharan Africa. Community-based accompaniment (CBA), including daily home visits and psychosocial and socioeconomic support, has been associated with improved patient outcomes at 1 year. We conducted a prospective observational cohort study of 578 HIV-infected adults initiating ART in 2007-2008 with or without CBA in rural Rwanda. Among patients without CBA, those with advanced HIV disease, low CD4 cell counts, lower social support, and transport costs had significantly higher odds of negative outcomes at 1 year; amongst patients who received CBA, only those with low CD4 cell counts had significantly higher odds of negative outcomes at 1 year. CBA also significantly mitigated the effect of transport costs and inaccessibility of services on the likelihood of negative outcome. CBA may be one approach to mitigating known risk factors for negative outcomes for patients on ART in resource-poor settings.

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Citations

Oct 16, 2016·Current HIV/AIDS Reports·Joia S MukherjeePaul E Farmer
Oct 19, 2016·The Pediatric Infectious Disease Journal·Felix Cyamatare RwabukwisiNeil Gupta
Jul 10, 2019·The Lancet. HIV·Sandeep PrabhuNagalingeswaran Kumarasamy
Sep 30, 2016·Pediatrics·Mary C Smith FawziTheresa S Betancourt

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