Home-based versus clinic-based care for patients starting antiretroviral therapy with low CD4⺠cell counts: findings from a cluster-randomized trial.
AIDS
; 28(4): 569-76, 2014 Feb 20.
Article
em En
| MEDLINE
| ID: mdl-24468997
ABSTRACT
OBJECTIVES:
African health services have shortages of clinical staff. We showed previously, in a cluster-randomized trial, that a home-based strategy using trained lay-workers is as effective as a clinic-based strategy. It is not known whether home-based care is suitable for patients with advanced HIV disease.METHODS:
The trial was conducted in Jinja, Uganda. One thousand, four hundred and fifty-three adults initiating ART between February 2005 and January 2009 were randomized to receive either home-based care or routine clinic-based care, and followed up for about 3 years. Trained lay workers, supervised by clinical staff based in a clinic, delivered the home-based care. In this sub-analysis, we compared survival between the two strategies for those who presented with CD4⺠cell count less than 50 cells/µl and those who presented with higher CD4⺠cell counts. We used Kaplan-Meier methods and Poisson regression.RESULTS:
Four hundred and forty four of 1453 (31%) participants had baseline CD4⺠cell count less than 50âcells/µl. Overall, 110 (25%) deaths occurred among participants with baseline CD4⺠cell count less than 50 âcells/µl and 87 (9%) in those with higher CD4⺠cell count. Among participants with CD4 cell count less than 50 âcells/µl, mortality rates were similar for the home and facility-based arms; adjusted mortality rate ratio 0.80 [95% confidence interval (CI) 0.53-1.18] compared with 1.22 (95% CI 0.78-1.89) for those who presented with higher CD4⺠cell count.CONCLUSION:
HIV home-based care, with lay workers playing a major role in the delivery of care including providing monthly adherence support, leads to similar survival rates as clinic-based care even among patients who present with very low CD4⺠cell count. This emphasises the critical role of adherence to antiretroviral therapy.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Infecções por HIV
/
Terapia Antirretroviral de Alta Atividade
/
Antirretrovirais
/
Assistência Ambulatorial
Tipo de estudo:
Clinical_trials
/
Diagnostic_studies
Limite:
Adult
/
Female
/
Humans
/
Male
/
Middle aged
País como assunto:
Africa
Idioma:
En
Ano de publicação:
2014
Tipo de documento:
Article