Effectiveness of patient adherence groups as a model of care for stable patients on antiretroviral therapy in Khayelitsha, Cape Town, South Africa


Luque-Fernandez, MA; Van Cutsem, G; Goemaere, E; Hilderbrand, K; Schomaker, M; Mantangana, N; Mathee, S; Dubula, V; Ford, N; Hernán, MA; Boulle, A; (2013) Effectiveness of patient adherence groups as a model of care for stable patients on antiretroviral therapy in Khayelitsha, Cape Town, South Africa. PloS one, 8 (2). e56088. ISSN 1932-6203 DOI: https://doi.org/10.1371/journal.pone.0056088

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Abstract

: Innovative models of care are required to cope with the ever-increasing number of patients on antiretroviral therapy in the most affected countries. This study, in Khayelitsha, South Africa, evaluates the effectiveness of a group-based model of care run predominantly by non-clinical staff in retaining patients in care and maintaining adherence.<br/> : Participation in "adherence clubs" was offered to adults who had been on ART for at least 18 months, had a current CD4 count >200 cells/ml and were virologically suppressed. Embedded in an ongoing cohort study, we compared loss to care and virologic rebound in patients receiving the intervention with patients attending routine nurse-led care from November 2007 to February 2011. We used inverse probability weighting to estimate the intention-to-treat effect of adherence club participation, adjusted for measured baseline and time-varying confounders. The principal outcome was the combination of death or loss to follow-up. The secondary outcome was virologic rebound in patients who were virologically suppressed at study entry. Of 2829 patients on ART for >18 months with a CD4 count above 200 cells/µl, 502 accepted club participation. At the end of the study, 97% of club patients remained in care compared with 85% of other patients. In adjusted analyses club participation reduced loss-to-care by 57% (hazard ratio [HR] 0.43, 95% CI = 0.21-0.91) and virologic rebound in patients who were initially suppressed by 67% (HR 0.33, 95% CI = 0.16-0.67).<br/> : Patient adherence groups were found to be an effective model for improving retention and documented virologic suppression for stable patients in long term ART care. Out-of-clinic group-based models facilitated by non-clinical staff are a promising approach to assist in the long-term management of people on ART in high burden low or middle-income settings.<br/>

Item Type: Article
Keywords: Adult, Aged, Antiretroviral Therapy, Highly Active, CD4 Lymphocyte Count, Cohort Studies, Delivery of Health Care, methods, statistics & numerical data, Female, HIV Infections, drug therapy, Humans, Logistic Models, Male, Middle Aged, Outcome Assessment (Health Care), statistics & numerical data, Patient Compliance, statistics & numerical data, Recurrence, South Africa, Viral Load, Young Adult
Faculty and Department: Faculty of Epidemiology and Population Health > Dept of Non-Communicable Disease Epidemiology
PubMed ID: 23418518
Web of Science ID: 315970300110
URI: http://researchonline.lshtm.ac.uk/id/eprint/2305235

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