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Community-based DOT-HAART Accompaniment in an Urban Resource-Poor Setting

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Abstract

From December 2005 to April 2007, we enrolled 60 adults starting antiretroviral therapy (ART) in a health district of Lima, Peru to receive community-based accompaniment with supervised antiretroviral (CASA). Paid community health workers performed twice-daily home visits to directly observe ART and offered additional medical, social and economic support to CASA participants. We matched 60 controls from a neighboring district by age, CD4 and primary referral criteria (TB status, female, neither). Using validated instruments at baseline and 12 months (time of DOT-HAART completion) we measured depression, social support, quality of life, HIV-related stigma and self-efficacy. We compared 12 month clinical and psychosocial outcomes among CASA versus control groups. CASA participants experienced better clinical and psychosocial outcomes at 12 months, including proportion with virologic suppression, increase in social support and reduction in HIV-associated stigma.

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References

  • Bangsberg, D. R., Hecht, F. M., Charlebois, E. D., Zolopa, A. R., Holodniy, M., Sheiner, L., et al. (2000). Adherence to protease inhibitors, HIV-1 viral load, and development of drug resistance in an indigent population. AIDS (London, England), 14(4), 357–366. doi:10.1097/00002030-200003100-00008.

    CAS  Google Scholar 

  • Behforouz, H. L., Kalmus, A., Scherz, C. S., Kahn, J. S., Kadakia, M. B., & Farmer, P. E. (2004). Directly observed therapy for HIV antiretroviral therapy in an urban US setting. Journal of Acquired Immune Deficiency Syndromes, 36(1), 642–645. doi:10.1097/00126334-200405010-00016.

    Article  PubMed  Google Scholar 

  • Berger, B. E., Ferrans, C. E., & Lashley, F. R. (2001). Measuring stigma in people with HIV: Psychometric assessment of the HIV stigma scale. Research in Nursing & Health, 24(6), 518–529. doi:10.1002/nur.10011.

    Article  CAS  Google Scholar 

  • Bisson, G. P., Gaolathe, T., Gross, R., Rollins, C., Bellamy, S., Mogorosi, M., et al. (2008). Overestimates of survival after HAART: Implications for global scale-up efforts. PLoS ONE, 3(3), e1725.

    Article  PubMed  Google Scholar 

  • Bradley-Ewing, A., Thomson, D., Pinkston, M., & Goggin, K. J. (2008). A qualitative examination of the indirect effects of modified directly observed therapy on health behaviors other than adherence. AIDS Patient Care and STDs, 22(8), 663–668. doi:10.1089/apc.2007.0190.

    Article  PubMed  Google Scholar 

  • Broadhead, W. E., Gehlbach, S. H., de Gruy, F. V., & Kaplan, B. H. (1988). The Duke-UNC functional social support questionnaire. Measurement of social support in family medicine patients. Medical Care, 26(7), 709–723. doi:10.1097/00005650-198807000-00006.

    Article  CAS  PubMed  Google Scholar 

  • Bronfenbrenner, U. (1979). The ecology of human development: Experiments by nature and design. Cambridge: Harvard University Press.

    Google Scholar 

  • Bukusuba, J., Kikafunda, J. K., & Whitehead, R. G. (2007). Food security status in households of people living with HIV/AIDS (PLWHA) in a Ugandan urban setting. The British Journal of Nutrition, 98(1), 211–217. doi:10.1017/S0007114507691806.

    Article  CAS  PubMed  Google Scholar 

  • Byakika-Tusiime, J., Oyugi, J. H., Tumwikirize, W. A., Katabira, E. T., Mugyenyi, P. N., & Bangsberg, D. R. (2003). Ability to purchase and secure stable therapy are significant predictors of non-adherence to antiretroviral therapy in Kampala, Uganda. Presented February 10–14, 2003 at the 10th Conference on Retroviruses and Opportunistic Infections (CROI), Boston, MA. Abstract #170 retrieved from http://www.retroconference.org/2003/cd/Abstract/170.htm.

  • Castro, A. (2005). Adherence to antiretroviral therapy: Merging the clinical and social course of AIDS. PLoS Medicine, 2(12), e338. doi:10.1371/journal.pmed.0020338.

    Article  PubMed  Google Scholar 

  • Castro, A., & Farmer, P. (2005). Understanding and addressing AIDS-related stigma: From anthropological theory to clinical practice in Haiti. American Journal of Public Health, 95(1), 53–59. doi:10.2105/AJPH.2003.028563.

    Article  PubMed  Google Scholar 

  • Chen, S. C., Yu, J. K., Harries, A. D., Bong, C. N., Kolola-Dzimadzi, R., Tok, T. S., King, C. C., & Wang, J. D. (2008). Increased mortality of male adults with AIDS related to poor compliance to antiretroviral therapy in Malawi. Tropical Medicine & International Health. doi: 10.1111/j.1365-3165.2008.02029.x.

  • Chesney, M. A., Ickovics, J. R., Chambers, D. B., Gifford, A. L., Neidig, J., Zwickl, B., et al. (2000). Self-reported adherence to antiretroviral medications among participants in HIV clinical trials: The AACTG adherence instruments. Patient care committee & adherence working group of the outcomes committee of the adult AIDS clinical trials group (AACTG). AIDS Care, 12(3), 255–266. doi:10.1080/09540120050042891.

    Article  CAS  PubMed  Google Scholar 

  • Derogatis, L. R., Lipman, R. S., Rickels, K., Uhlenhuth, E. H., & Covi, L. (1974). The hopkins symptom checklist (HSCL): A self-report symptom inventory. Behavioral Science, 19(1), 1–15. doi:10.1002/bs.3830190102.

    Article  CAS  PubMed  Google Scholar 

  • Farmer, P., Leandre, F., Mukherjee, J. S., Claude, M., Nevil, P., Smith-Fawzi, M. C., et al. (2001). Community-based approaches to HIV treatment in resource-poor settings. Lancet, 358(9279), 404–409. doi:10.1016/S0140-6736(01)05550-7.

    Article  CAS  PubMed  Google Scholar 

  • Gill, C. J., Hamer, D. H., Simon, J. L., Thea, D. M., & Sabin, L. L. (2005). No room for complacency about adherence to antiretroviral therapy in sub-Saharan Africa. AIDS (London, England), 19(12), 1243–1249. doi:10.1097/01.aids.0000180094.04652.3b.

    Google Scholar 

  • Hardon, A. P., Akurut, D., Comoro, C., Ekezie, C., Irunde, H. F., Gerrits, T., et al. (2007). Hunger, waiting time and transport costs: Time to confront challenges to ART adherence in Africa. AIDS Care, 19(5), 658–665. doi:10.1080/09540120701244943.

    Article  CAS  PubMed  Google Scholar 

  • Idoko, J. A., Agbaji, O., Agaba, P., Akolo, C., Inuwa, B., Hassan, Z., et al. (2007). Direct observation therapy-highly active antiretroviral therapy in a resource-limited setting: The use of community treatment support can be effective. International Journal of STD & AIDS, 18(11), 760–763. doi:10.1258/095646207782212252.

    Article  CAS  Google Scholar 

  • Kadiyala, S., & Gillespie, S. (2004). Rethinking food aid to fight AIDS. Food and Nutrition Bulletin, 25(3), 271–282.

    PubMed  Google Scholar 

  • Koenig, S. P., Leandre, F., & Farmer, P. E. (2004). Scaling-up HIV treatment programmes in resource-limited settings: The rural Haiti experience. AIDS (London, England), 18(Suppl. 3), S21–S25. doi:10.1097/00002030-200406003-00005.

    Google Scholar 

  • Larsson, E. C., Okong, P., Thorson, A., & Ekstrom, A. M. (2007). Antiretroviral treatment of HIV in Uganda: A comparison of three different delivery models in a single hospital. Transactions of the Royal Society of Tropical Medicine and Hygiene, 101(9), 885–892. doi:10.1016/j.trstmh.2007.04.024.

    Article  PubMed  Google Scholar 

  • Liechty, C. A., & Bangsberg, D. R. (2003). Doubts about DOT: Antiretroviral therapy for resource-poor countries. AIDS (London, England), 17(9), 1383–1387. doi:10.1097/00002030-200306130-00013.

    Google Scholar 

  • Mills, E. J., Nachega, J. B., Buchan, I., Orbinski, J., Attaran, A., Singh, S., et al. (2006). Adherence to antiretroviral therapy in sub-Saharan Africa and North America: A meta-analysis. Journal of the American Medical Association, 296(6), 679–690. doi:10.1001/jama.296.6.679.

    Article  CAS  PubMed  Google Scholar 

  • Mukherjee, J. S., Ivers, L., Leandre, F., Farmer, P., & Behforouz, H. (2006). Antiretroviral therapy in resource-poor settings: Decreasing barriers to access and promoting adherence. Journal of Acquired Immune Deficiency Syndromes, 43(Suppl. 1), S123–S126. doi:10.1097/01.qai.0000248348.25630.74.

    PubMed  Google Scholar 

  • Muyingo, S. K., Walker, A. S., Reid, A., Munderi, P., Gibb, D. M., Ssali, F., et al. (2008). Patterns of individual and population-level adherence to antiretroviral therapy and risk factors for poor adherence in the first year of the DART trial in Uganda and Zimbabwe. Journal of Acquired Immune Deficiency Syndromes, 48(4), 468–475.

    Article  PubMed  Google Scholar 

  • Nachega, J. B., Knowlton, A. R., Deluca, A., Schoeman, J. H., Watkinson, L., Efron, A., et al. (2006). Treatment supporter to improve adherence to antiretroviral therapy in HIV-infected South African adults. A qualitative study. Journal of Acquired Immune Deficiency Syndromes, 43(Suppl. 1), S127–S133. doi:10.1097/01.qai.0000248349.25630.3d.

    PubMed  Google Scholar 

  • Partners In Health. (2008). Partners in health 2008 annual report. Available from http://www.pih.org/inforesources/annual/PIH2008_annualreport.pdf.

  • Pearson, C. R., Micek, M. A., Simoni, J. M., Hoff, P. D., Matediana, E., Martin, D. P., et al. (2007). Randomized control trial of peer-delivered, modified directly observed therapy for HAART in Mozambique. Journal of Acquired Immune Deficiency Syndromes, 46(2), 238–244. doi:10.1097/QAI.0b013e318153f7ba.

    Article  CAS  PubMed  Google Scholar 

  • Phillips, A. N., Leen, C., Wilson, A., Anderson, J., Dunn, D., Schwenk, A., et al. (2007). Risk of extensive virological failure to the three original antiretroviral drug classes over long-term follow-up from the start of therapy in patients with HIV infection: An observational cohort study. Lancet, 370(9603), 1923–1928. doi:10.1016/S0140-6736(07)61815-7.

    Article  CAS  PubMed  Google Scholar 

  • Population Reference Bureau. (2006). 2006 World population data sheet. 2006, Available from http://www.prb.org/pdf06/06WorldDataSheet.pdf.

  • Rosen, S., Fox, M. P., & Gill, C. J. (2007). Patient retention in antiretroviral therapy programs in sub-Saharan Africa: A systematic review. PLoS Medicine, 4(10), e298. doi:10.1371/journal.pmed.0040298.

    Article  PubMed  Google Scholar 

  • Sarna, A., Luchters, S., Geibel, S., Chersich, M. F., Munyao, P., Kaai, S., et al. (2008). Short- and long-term efficacy of modified directly observed antiretroviral treatment in Mombasa, Kenya: A randomized trial. Journal of Acquired Immune Deficiency Syndromes, 48(5), 611–619.

    Article  CAS  PubMed  Google Scholar 

  • Schafer, J. (1997). Analysis of incomplete multivariate data. New York: Chapman and Hall.

    Google Scholar 

  • Semba, R. D., Caiaffa, W. T., Graham, N. M., Cohn, S., & Vlahov, D. (1995). Vitamin A deficiency and wasting as predictors of mortality in human immunodeficiency virus-infected injection drug users. The Journal of Infectious Diseases, 171(5), 1196–1202.

    CAS  PubMed  Google Scholar 

  • Shin, S., Munoz, M., Espiritu, B., Zeladita, J., Sanchez, E., Callacna, M., et al. (2008). Psychosocial impact of poverty on antiretroviral nonadherence among HIV-TB coinfected patients in Lima, Peru. Journal of the International Association of Physicians in AIDS Care, 7(2), 74–81. doi:10.1177/1545109708315326.

    Article  PubMed  Google Scholar 

  • Shively, M., Smith, T., Bormann, J., & Gifford, A. (2002). Evaluating self-efficacy for HIV disease management skills. AIDS and Behavior, 6, 371–379. doi:10.1023/A:1021156914683.

    Article  Google Scholar 

  • Simoni, J. M., Pearson, C. R., Pantalone, D. W., Marks, G., & Crepaz, N. (2006). Efficacy of interventions in improving highly active antiretroviral therapy adherence and HIV-1 RNA viral load. A meta-analytic review of randomized controlled trials. Journal of Acquired Immune Deficiency Syndromes, 43(Suppl. 1), S23–S35. doi:10.1097/01.qai.0000248342.05438.52.

    PubMed  Google Scholar 

  • Smith, S. R., Rublein, J. C., Marcus, C., Brock, T. P., & Chesney, M. A. (2003). A medication self-management program to improve adherence to HIV therapy regimens. Patient Education and Counseling, 50(2), 187–199.

    PubMed  Google Scholar 

  • Spacek, L. A., Shihab, H. M., Kamya, M. R., Mwesigire, D., Ronald, A., Mayanja, H., et al. (2006). Response to antiretroviral therapy in HIV-infected patients attending a public, urban clinic in Kampala, Uganda. Clinical Infectious Diseases, 42(2), 252–259. doi:10.1086/499044.

    Article  PubMed  Google Scholar 

  • Tuboi, S. H., Harrison, L. H., Sprinz, E., Albernaz, R. K., & Schechter, M. (2005). Predictors of virologic failure in HIV-1-infected patients starting highly active antiretroviral therapy in Porto Alegre, Brazil. Journal of Acquired Immune Deficiency Syndromes, 40(3), 324–328. doi:10.1097/01.qai.0000182627.28595.01.

    Article  PubMed  Google Scholar 

  • Van Der Ven, N. C., Weinger, K., Yi, J., Pouwer, F., Ader, H., Van Der Ploeg, H. M., et al. (2003). The confidence in diabetes self-care scale: psychometric properties of a new measure of diabetes-specific self-efficacy in Dutch and US patients with type 1 diabetes. Diabetes Care, 26(3), 713–718. doi:10.2337/diacare.26.3.713.

    Article  Google Scholar 

  • van Oosterhout, J. J., Bodasing, N., Kumwenda, J. J., Nyirenda, C., Mallewa, J., Cleary, P. R., et al. (2005). Evaluation of antiretroviral therapy results in a resource-poor setting in Blantyre, Malawi. Tropical Medicine & International Health, 10(5), 464–470. doi:10.1111/j.1365-3156.2005.01409.x.

    Article  Google Scholar 

  • Wainberg, M. A., & Friedland, G. (1998). Public health implications of antiretroviral therapy and HIV drug resistance. Journal of the American Medical Association, 279(24), 1977–1983. doi:10.1001/jama.279.24.1977.

    Article  CAS  PubMed  Google Scholar 

  • Wakabi, W. (2008). Low ART adherence in Africa. The Lancet Infectious Diseases, 8(2), 94. doi:10.1016/S1473-3099(08)70010-0.

    Article  PubMed  Google Scholar 

  • World Health Organization. (2003). Scaling up antiretroviral therapy in resource-limited settings: Treatment guidelines for a public health approach. Available from http://www.who.int/3by5/publications/documents/arv_guidelines/en/.

  • Wu, A. W., Rubin, H. R., Mathews, W. C., Ware, J. E., Jr, Brysk, L. T., Hardy, W. D., et al. (1991). A health status questionnaire using 30 items from the medical outcomes study. Preliminary validation in persons with early HIV infection. Medical Care, 29(8), 786–798. doi:10.1097/00005650-199108000-00011.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

We would like to acknowledge the Office for AIDS Research at the National Institutes for Health; the Eleanor and Miles Shore Fellowship at Harvard Medical School; David Rockefeller Center for Latin American Studies at Harvard University, and Partners In Health for support of this project.

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Authors and Affiliations

  1. Socios En Salud Sucursal Perú, Lima, Peru

    Maribel Muñoz, Jhon Zeladita, Jaime Bayona & Sonya Shin

  2. Rollins School of Public Health, Emory University, Atlanta, GA, USA

    Karen Finnegan

  3. Division of Global Health Equity, Brigham and Women’s Hospital, FXB Building, 7th Floor, 651 Huntington Avenue, Boston, MA, 02115, USA

    Adolfo Caldas & Sonya Shin

  4. Hospital Nacional Hipólito Unanue, Lima, Peru

    Eduardo Sanchez, Miriam Callacna & Christian Rojas

  5. Hospital Dos de Mayo, Lima, Peru

    Jorge Arevalo

  6. Peruvian HIV Program, Ministerio de Salud, Lima, Peru

    Jose Luis Sebastian

  7. Peruvian TB Program, Ministerio de Salud, Lima, Peru

    Cesar Bonilla

  8. Harvard Medical School, Boston, MA, USA

    Sonya Shin

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  1. Maribel Muñoz
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  2. Karen Finnegan
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  3. Jhon Zeladita
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  11. Jaime Bayona
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  12. Sonya Shin
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Correspondence to Sonya Shin.

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Muñoz, M., Finnegan, K., Zeladita, J. et al. Community-based DOT-HAART Accompaniment in an Urban Resource-Poor Setting. AIDS Behav 14, 721–730 (2010). https://doi.org/10.1007/s10461-009-9559-5

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