Current HIV/AIDS Reports

, Volume 13, Issue 5, pp 241–255 | Cite as

Community-Based Interventions to Improve and Sustain Antiretroviral Therapy Adherence, Retention in HIV Care and Clinical Outcomes in Low- and Middle-Income Countries for Achieving the UNAIDS 90-90-90 Targets

  • Jean B. Nachega
  • Olatunji Adetokunboh
  • Olalekan A. Uthman
  • Amy W. Knowlton
  • Frederick L. Altice
  • Mauro Schechter
  • Omar Galárraga
  • Elvin Geng
  • Karl Peltzer
  • Larry W. Chang
  • Gilles Van Cutsem
  • Shabbar S. Jaffar
  • Nathan Ford
  • Claude A. Mellins
  • Robert H. Remien
  • Edward J. Mills
The Global Epidemic (SH Vermund, Section Editor)
Part of the following topical collections:
  1. Topical Collection on The Global Epidemic

Abstract

Little is known about the effect of community versus health facility-based interventions to improve and sustain antiretroviral therapy (ART) adherence, virologic suppression, and retention in care among HIV-infected individuals in low- and middle-income countries (LMICs). We systematically searched four electronic databases for all available randomized controlled trials (RCTs) and comparative cohort studies in LMICs comparing community versus health facility-based interventions. Relative risks (RRs) for pre-defined adherence, treatment engagement (linkage and retention in care), and relevant clinical outcomes were pooled using random effect models. Eleven cohort studies and eleven RCTs (N = 97,657) were included. Meta-analysis of the included RCTs comparing community- versus health facility-based interventions found comparable outcomes in terms of ART adherence (RR = 1.02, 95 % CI 0.99 to 1.04), virologic suppression (RR = 1.00, 95 % CI 0.98 to 1.03), and all-cause mortality (RR = 0.93, 95 % CI 0.73 to 1.18). The result of pooled analysis from the RCTs (RR = 1.03, 95 % CI 1.01 to 1.06) and cohort studies (RR = 1.09, 95 % CI 1.03 to 1.15) found that participants assigned to community-based interventions had statistically significantly higher rates of treatment engagement. Two studies found community-based ART delivery model either cost-saving or cost-effective. Community- versus facility-based models of ART delivery resulted in at least comparable outcomes for clinically stable HIV-infected patients on treatment in LMICs and are likely to be cost-effective.

Keywords

Community Interventions ART Adherence Retention LMIC 

Supplementary material

11904_2016_325_MOESM1_ESM.docx (14 kb)
ESM 1(DOCX 14 kb)

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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Jean B. Nachega
    • 1
    • 2
    • 3
  • Olatunji Adetokunboh
    • 2
  • Olalekan A. Uthman
    • 2
    • 4
  • Amy W. Knowlton
    • 3
  • Frederick L. Altice
    • 5
  • Mauro Schechter
    • 6
  • Omar Galárraga
    • 7
  • Elvin Geng
    • 8
  • Karl Peltzer
    • 9
    • 10
    • 11
  • Larry W. Chang
    • 3
  • Gilles Van Cutsem
    • 12
  • Shabbar S. Jaffar
    • 13
  • Nathan Ford
    • 14
  • Claude A. Mellins
    • 15
  • Robert H. Remien
    • 16
  • Edward J. Mills
    • 17
  1. 1.University of Pittsburgh Graduate School of Public HealthPittsburghUSA
  2. 2.Stellenbosch University Faculty of Medicine and Health SciencesCape TownSouth Africa
  3. 3.Johns Hopkins UniversityBaltimoreUSA
  4. 4.Warwick Medical SchoolThe University of WarwickCoventryUK
  5. 5.Yale University School of Medicine and Public HealthYaleUSA
  6. 6.Projeto Praça OnzeRio de JaneiroBrazil
  7. 7.Brown University School of Public HealthProvidenceUSA
  8. 8.University of CaliforniaSan FranciscoUSA
  9. 9.Mahidol UniversitySalayaThailand
  10. 10.University of LimpopoPolokwaneSouth Africa
  11. 11.Human Sciences Research CouncilPretoriaSouth Africa
  12. 12.Médecins Sans FrontièresCape TownSouth Africa
  13. 13.Liverpool School of Tropical MedicineLiverpoolUK
  14. 14.World Health OrganizationGenevaSwitzerland
  15. 15.HIV Center for Clinical and Behavioral StudiesColumbia UniversityNew YorkUSA
  16. 16.New York State Psychiatric InstituteNew YorkUSA
  17. 17.Precision Global HealthVancouverCanada

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