Effectiveness of Patient Adherence Groups as a Model of Care for Stable Patients on Antiretroviral Therapy in Khayelitsha, Cape Town, South Africa
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Luque-Fernandez-2013-Effectiveness of Pat.pdf
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Author(s)
Hernan, Miguel Angel
Luque-Fernandez, Miguel Angel
Cutsem, Gilles Van
Goemaere, Eric
Hilderbrand, Katherine
Schomaker, Michael
Mantangana, Nompumelelo
Mathee, Shaheed
Dubula, Vuyiseka
Ford, Nathan
Date Issued
February 2013
Journal
PLoS ONE
Publisher
Public Library of Science
Citation
Luque-Fernandez, Miguel Angel et al. “Effectiveness of Patient Adherence Groups as a Model of Care for Stable Patients on Antiretroviral Therapy in Khayelitsha, Cape Town, South Africa.” Ed. David W. Dowdy. PLoS ONE 8.2 (2013): e56088.
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Final published version
Abstract
Abstract: Background: Innovative models of care are required to cope with the ever-increasing number of patients on antiretroviral therapy in the most affected countries. This study, in Khayelitsha, South Africa, evaluates the effectiveness of a group-based model of care run predominantly by non-clinical staff in retaining patients in care and maintaining adherence.
Methods and Findings: Participation in ‘‘adherence clubs’’ was offered to adults who had been on ART for at least 18 months, had a current CD4 count .200 cells/ml and were virologically suppressed. Embedded in an ongoing cohort study, we compared loss to care and virologic rebound in patients receiving the intervention with patients attending routine nurse-led care from November 2007 to February 2011. We used inverse probability weighting to estimate the intention-totreat effect of adherence club participation, adjusted for measured baseline and time-varying confounders. The principal
outcome was the combination of death or loss to follow-up. The secondary outcome was virologic rebound in patients who were virologically suppressed at study entry. Of 2829 patients on ART for .18 months with a CD4 count above 200 cells/ml,
502 accepted club participation. At the end of the study, 97% of club patients remained in care compared with 85% of other patients. In adjusted analyses club participation reduced loss-to-care by 57% (hazard ratio [HR] 0.43, 95% CI = 0.21–0.91) and
virologic rebound in patients who were initially suppressed by 67% (HR 0.33, 95% CI = 0.16–0.67).
Discussion: Patient adherence groups were found to be an effective model for improving retention and documented virologic suppression for stable patients in long term ART care. Out-of-clinic group-based models facilitated by non-clinical staff are a promising approach to assist in the long-term management of people on ART in high burden low or middleincome settings.
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Harvard University--MIT Division of Health Sciences and Technology
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DOI of Published Version
https://doi.org/10.1371/journal.pone.0056088
