Evaluation of a community-based ART programme after tapering home visits in rural Sierra Leone: a 24-month retrospective study

Abstract

Evaluations of community-based antiretroviral therapy (ART) programmes have demonstrated positive outcomes, but little is known about the impact of tapering community-based ART. The objective of this study was to assess 24-month HIV retention outcomes of a community-based ART programme and its tapered visit frequency in Koidu City, Sierra Leone. This retrospective, quasi-experimental study compared outcomes of 52 HIV-infected persons initiated on community-based ART against 91 HIV-infected persons receiving the standard of care from November 2009 to February 2013. The community-based ART pilot programme was designed to strengthen the standard of care through a comprehensive, patient-centred case management strategy. The strategy included medical, educational, psychological, social, and economic support. Starting in October 2011, the frequency of home visits was tapered from twice daily every day per week to once daily three days per week. Outcomes were retention in care at 12 and 24 months and adherence to ART over a three-month time period. Participants who received community-based ART had significantly higher retention than those receiving standard of care. At 12 months, retention rates for community-based ART and standard of care were 61.5% and 31.9%, respectively (p < .01). At 24 months, retention rates for community-based ART and standard of care were 73.1% and 44.0%, respectively (p < .01). Significant differences in levels of adherence were observed when comparing community-based ART against persons receiving standard of care (p < .05). No differences in adherence levels were observed between groups of people receiving various frequencies of home visits. Our pilot programme in Koidu City provides new evidence that community-based ART has the potential to improve retention and adherence outcomes for HIV-infected persons, regardless of the frequency of home visits. Overcoming the barriers to HIV care requires a comprehensive, patient-centred approach that may include clinic-based and community-based interventions.

Barriers and facilitators in the implementation of bio-psychosocial care at the primary healthcare level in South Kivu, Democratic Republic of Congo

“…They could then become agents of change in the relationship between professionals at the HC and in the community. 27 , 28 , 29 …”

“…They could then become agents of change in the relationship between professionals at the HC and in the community. 27,28,29 Bio-psychosocial care approach facilitators as grassroots initiative: What are possible solutions to a difficult change?…”

Effects of the implementation of the HIV Treat All guidelines on key ART treatment outcomes in Namibia

“…In other countries, for example, weakness in drug supply chains have challenged the success of HIV care outside of district hospitals [26]. Availability of and support for trained community health workers or patient peers to enable the success of models for delivering ART in communities has also proven a challenge in other countries and needs to be carefully provided for and monitored in Namibia [28].…”

Early Success With Retention in Care Among People Living With HIV at Decentralized ART Satellite Sites in Yangon, Myanmar, 2015–2016

“…Two systematic reviews of peer interventions for HIV have shown an effect on behavioral outcomes but mixed results on clinical outcomes, noting a lack of well-designed comparative studies (16, 17). A study from an Africa country with a similar community based care service model reported high retention among HIV patients on ART compared with the standard of care (73 vs. 44%) (18).…”