Community adherence support improves programme retention in children on antiretroviral treatment: a multicentre cohort study in South Africa

• DOI: 10.7448/ias.15.2.17381
• Publication Date: 2012-06-08T17:59:53Z
• Authors: Ashraf Grimwood; Geoffrey Fatti; Eula Mothibi; Mokgadi Malahlela; Jawaya Shea; Brian Eley
• Keywords: Lost to follow-up; Retention rate

Background HIV‐positive children in low‐income settings face many challenges to adherence antiretroviral treatment (ART) and have increased mortality on compared developed countries. Adult ART programmes demonstrated benefit from community support improve outcomes; however, there are no empirical data the effectiveness of this intervention children. This study clinical, virological immunological outcomes between who received did not receive community‐based patient advocates (PAs) four South African provinces. Methods A multicentre cohort ART‐naïve was conducted at 47 public facilities. Outcome measures were mortality, retention, suppression CD4 percentage changes ART. PAs lay health workers provide psychosocial for children's caregivers, they undertake home visits ascertain household potentially impacting child. Corrected estimates calculated, correcting deaths amongst those lost follow‐up (LTFU) using probability‐weighted Kaplan‐Meier Cox functions. Results Three thousand five hundred sixty three included with a median baseline age 6.3 years cell 12.0%. PA‐supported numbered 323 (9.1%). Baseline clinical status variables equivalent two groups. Amongst LTFU, 38.7% known died. Patient retention after 3 91.5% (95% CI: 86.8% 94.7%) vs. 85.6% 83.3% 87.6%) without PAs, respectively ( p = 0.027). aged below 2 baseline, 92.2% 76.7% 97.6%) 74.2% 65.4% 81.0%) p= 0.053). 3.7% 1.9% 7.4%) 8.0% 6.5% 9.8%) 0.060). In multivariable analyses, had reduced probabilities both attrition adjusted hazard ratio (AHR) 0.57 0.35 0.94) 0.39 0.15 1.04), respectively. Conclusion Community‐based is an effective way Expanded implementation should be considered order reach programmatic goals as more access treatment.