Improving Clinic Attendance and Adherence to Antiretroviral Therapy Through a Treatment Supporter Intervention in Uganda: A Randomized Controlled Trial
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We assessed the effectiveness of the treatment supporter initiative as an intervention in improving clinic attendance for antiretroviral (ARV) drug refills and adherence to antiretroviral therapy (ART) in a cohort of HIV-infected adults. This two-arm randomized controlled trial was undertaken at an HIV clinic in a district hospital in Uganda. A total of 174 adult patients on ART were randomized 1:1 to a standard adherence intervention package plus a treatment supporter intervention (TS arm) or to a standard adherence intervention package (non-TS arm) alone. Clinic attendance for refills and adherence measurements using monthly clinic-based pill counts were monitored for both arms for 28 weeks. Baseline characteristics were similar for both arms. There was a non-significant difference in mean adherence between the TS and non-TS groups at end of follow-up [99.1% (95% CI: 98.3–99.9% vs. 96.3% (95% CI: 94.2–98.3%), P > 0.05]. TS participants had more than four times the odds of achieving optimal adherence (≥95%) [Odds ratio (OR) = 4.51, 95% CI: 1.22–16.62, exact P = 0.027]. TS participants were also more likely to be on time for their clinic appointments: 91.6 vs. 90.1% for TS and non-TS, respectively (OR = 1.19, 95% CI: 0.74–1.91, P > 0.05). Use of patient-selected treatment supporters may be an effective intervention to improve ARV treatment outcomes in resource-constrained settings.
KeywordsTreatment supporter Clinic attendance Adherence Anti-retroviral therapy HIV/AIDS
We acknowledge the support of the Ugandan National AIDS Control Programme in facilitating this study. We thank the management and health workers of the Jinja Hospital. The study team also acknowledges the invaluable contributions of the adherence workers namely, Josephine Mirembe, Isaac Buzaka, Loyce Babirye, and Richard Olwa. The authors also wish to thank the partnership involving the United States Agency for International Development (USAID), Joint Clinical Research Centre (JCRC), and Uganda Health Communication Partnership for making available their adherence diaries to the study participants. Special thanks to all ART clients and members of the community including the treatment supporters who willingly participated in the study. Without their input, this study would not have been possible. The project was funded by the Communicable Disease Research Programme (COMDIS) Consortium led by the Nuffield Centre at Leeds University which itself is funded by the Department for International Development, United Kingdom.
Conflict of Interest
- 1.UNAIDS 2009 Report on the Global AIDS Epidemic. 2009. http://www.unaids.org/en/KnowledgeCentre/HIVData/EpiUpdate/EpiUpdArchive/2009/default.asp. Accessed 25 Mar 2010.
- 2.Uganda AIDS Commission, National HIV & AIDS Stakeholders & Services Mapping Report, June 2009. http://data.unaids.org/pub/Report/2010/uganda_2010_country_progress_report_en.pdf. Accessed 12 Oct 2010.
- 3.Uganda AIDS Commission. National Strategic Framework for HIV/AIDS. 2008. http://www.aidsuganda.org/. Accessed 25 Mar 2010.
- 18.WHO IMAI/IMCI Publications. http://www.who.int/hiv/pub/imai/en/index.html. Accessed 11 May 2010.
- 21.Chalker J, Andualem T, Tadeg H, et al. Developing standard methods to monitor adherence to antiretroviral medicines and treatment defaulting in resource-poor settings. The International Network for the Rational Use of Drugs Initiative on Adherence to Antiretroviral Therapy. Essent Med Monit. 2009;(1):4–8. Available at http://www.who.int/medicines/publications/monitor/EMM_art3Issue_1_2009.pdf. Accessed 11 May 2010.
- 26.Weiser S, Wolfe W, Bangsberg D, et al. Barriers to antiretroviral adherence for patients living with HIV and AIDS in Botswana. J Acquir Immune Defic Syndr. 2003;34(3):282–8.Google Scholar
- 36.Haynes RB. Determinants of compliance: the disease and the mechanics of treatment. In: Haynes RB, Sackett DL, editors. Compliance in health care. Baltimore: Johns Hopkins University Press; 1979. p. 49–62.Google Scholar
- 37.Horne R. Adherence to medication, a review of existing research. In: Myers L, Midence K, editors. Adherence to treatment in medical conditions. London: Harwood Academic; 1998. p. 285–310.Google Scholar