AIDS and Behavior

, Volume 20, Issue 5, pp 1009–1016 | Cite as

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

  • Neil Gupta
  • Christian Munyaburanga
  • Mwumvaneza Mutagoma
  • John W. Niyigena
  • Felix Kayigamba
  • Molly F. Franke
  • Bethany Hedt-Gauthier
Original Paper

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.

Keywords

Antiretroviral therapy Adherence Community-based accompaniment Virologic suppression Rwanda 

Resumen

Barreras clínicas, socioeconómicas, y del acceso siguen siendo un problema crítico para los programas de antiretrovirales (ART) en el Africa subsahariana. Acompañamiento basado en la comunidad (ABC), incluyendo visitas domiciliarias diarias y apoyo psicosocial y socioeconómico, se ha asociado con mejores resultados de los pacientes en un año. Realizamos un estudio de cohorte prospectivo observacional de 578 adultos infectados por el VIH que iniciaron ART entre 2007 y 2008, con o sin ABC en Ruanda rural. Entre los pacientes sin ABC, aquellos con enfermedad avanzada, recuentos bajos de células CD4, apoyo social más bajo, y costos de transporte tuvieron significativamente mayor probabilidad de resultados negativos en un año; entre los pacientes que recibieron ABC, solo aquellos con recuentos bajos de células CD4 tuvieron significativamente mayores probabilidades de resultados negativos en un año. ABC también mitigó significativamente el efecto de los costos de transporte y la inaccesibilidad a los servicios en la probabilidad de un resultado negativo. ABC puede ser un método para mitigar los factores de riesgo conocidos para los resultados negativos para los pacientes de ART en entornos con pocos recursos.

Palabras Claves

Terapia antiretroviral Adherencia Acompañamiento basado en la comunidad Supresión virológica Ruanda 

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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Neil Gupta
    • 1
    • 2
  • Christian Munyaburanga
    • 1
    • 3
  • Mwumvaneza Mutagoma
    • 4
  • John W. Niyigena
    • 1
  • Felix Kayigamba
    • 5
  • Molly F. Franke
    • 6
  • Bethany Hedt-Gauthier
    • 1
    • 6
  1. 1.Partners in Health/Inshuti Mu BuzimaRwinkwavuRwanda
  2. 2.Division of Global Health EquityBrigham and Women’s HospitalBostonUSA
  3. 3.School of Public Health, College of Medicine and Health SciencesUniversity of RwandaKigaliRwanda
  4. 4.Rwanda Biomedical CenterKigaliRwanda
  5. 5.Ministry of HealthKigaliRwanda
  6. 6.Department of Global Health and Social Medicine Harvard Medical SchoolBostonUSA

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