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

doi:10.1007/s11904-016-0325-9

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

Research output: Contribution to journal › Review article › peer-review

84 Scopus citations

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.

Original language	English
Pages (from-to)	241-255
Number of pages	15
Journal	Current HIV/AIDS Reports
Volume	13
Issue number	5
DOIs	https://doi.org/10.1007/s11904-016-0325-9
State	Published - Oct 1 2016

Keywords

ART
Adherence
Community
Interventions
LMIC
Retention

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Nachega, J. B., Adetokunboh, O., Uthman, O. A., Knowlton, A. W., Altice, F. L., Schechter, M., Galárraga, O., Geng, E., Peltzer, K., Chang, L. W., Van Cutsem, G., Jaffar, S. S., Ford, N., Mellins, C. A., Remien, R. H., & Mills, E. J. (2016). 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. Current HIV/AIDS Reports, 13(5), 241-255. https://doi.org/10.1007/s11904-016-0325-9

@article{8ecb400023024b06bd3e928d9930096b,

title = "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",

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 = "ART, Adherence, Community, Interventions, LMIC, Retention",

author = "Nachega, {Jean B.} and Olatunji Adetokunboh and Uthman, {Olalekan A.} and Knowlton, {Amy W.} and Altice, {Frederick L.} and Mauro Schechter and Omar Gal{\'a}rraga and Elvin Geng and Karl Peltzer and Chang, {Larry W.} and {Van Cutsem}, Gilles and Jaffar, {Shabbar S.} and Nathan Ford and Mellins, {Claude A.} and Remien, {Robert H.} and Mills, {Edward J.}",

note = "Funding Information: Frederick L. Altice is funded by the National Institutes on Drug Abuse for Research (R01-DA 10186; R01-DA 13805; R01-DA 017072). Funding Information: Jean B. Nachega receives research grant support from the National Institutes of Health/National Institutes for Allergy and Infectious Disease, the AIDS Clinical Trial Group (ACTG)/Stellenbosch University Clinical Trial Unit (2UM1AI069521-08); the US President Emergency Plan for AIDS Relief (PEPFAR; T84HA21652-01-00) for Medical Education Partnership Initiative; the Stellenbosch University Collaborative Capacity Enhancement through Engagement with Districts (SUCCEED; 1 U2GGH001536-01); and the Wellcome Trust Southern Africa Consortium for Research Excellence (WT087537MA). Funding Information: Olalekan A. Uthman acknowledges support from the FAS Marie Curie International PostDoc (2012-0064). Funding Information: We thank Drs. Badara Samb and Martina Brostrom from the Joint United Nations Programme on HIV/AIDS (UNAIDS), Geneva, Switzerland, for their critical review and advises on this manuscript. Dr. Nachega receives research grant support from the National Institutes of Health/National Institutes for Allergy and Infectious Disease, the AIDS Clinical Trial Group (ACTG)/Stellenbosch University Clinical Trial Unit (2UM1AI069521-08); the US President Emergency Plan for AIDS Relief (PEPFAR; T84HA21652-01-00) for Medical Education Partnership Initiative; the Stellenbosch University Collaborative Capacity Enhancement through Engagement with Districts (SUCCEED; 1 U2GGH001536-01); and the Wellcome Trust Southern Africa Consortium for Research Excellence (WT087537MA). Dr. Altice is funded by the National Institutes on Drug Abuse for Research (R01-DA 10186; R01-DA 13805; R01-DA 017072). Dr. Uthman acknowledges support from the FAS Marie Curie International PostDoc (2012-0064). Publisher Copyright: {\textcopyright} 2016, Springer Science+Business Media New York.",

year = "2016",

month = oct,

day = "1",

doi = "10.1007/s11904-016-0325-9",

language = "English",

volume = "13",

pages = "241--255",

journal = "Current HIV/AIDS Reports",

issn = "1548-3568",

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Nachega, JB, Adetokunboh, O, Uthman, OA, Knowlton, AW, Altice, FL, Schechter, M, Galárraga, O, Geng, E, Peltzer, K, Chang, LW, Van Cutsem, G, Jaffar, SS, Ford, N, Mellins, CA, Remien, RH & Mills, EJ 2016, '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', Current HIV/AIDS Reports, vol. 13, no. 5, pp. 241-255. https://doi.org/10.1007/s11904-016-0325-9

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. / Nachega, Jean B.; Adetokunboh, Olatunji; Uthman, Olalekan A. et al.
In: Current HIV/AIDS Reports, Vol. 13, No. 5, 01.10.2016, p. 241-255.

Research output: Contribution to journal › Review article › peer-review

TY - JOUR

T1 - 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

AU - Nachega, Jean B.

AU - Adetokunboh, Olatunji

AU - Uthman, Olalekan A.

AU - Knowlton, Amy W.

AU - Altice, Frederick L.

AU - Schechter, Mauro

AU - Galárraga, Omar

AU - Geng, Elvin

AU - Peltzer, Karl

AU - Chang, Larry W.

AU - Van Cutsem, Gilles

AU - Jaffar, Shabbar S.

AU - Ford, Nathan

AU - Mellins, Claude A.

AU - Remien, Robert H.

AU - Mills, Edward J.

N1 - Funding Information: Frederick L. Altice is funded by the National Institutes on Drug Abuse for Research (R01-DA 10186; R01-DA 13805; R01-DA 017072). Funding Information: Jean B. Nachega receives research grant support from the National Institutes of Health/National Institutes for Allergy and Infectious Disease, the AIDS Clinical Trial Group (ACTG)/Stellenbosch University Clinical Trial Unit (2UM1AI069521-08); the US President Emergency Plan for AIDS Relief (PEPFAR; T84HA21652-01-00) for Medical Education Partnership Initiative; the Stellenbosch University Collaborative Capacity Enhancement through Engagement with Districts (SUCCEED; 1 U2GGH001536-01); and the Wellcome Trust Southern Africa Consortium for Research Excellence (WT087537MA). Funding Information: Olalekan A. Uthman acknowledges support from the FAS Marie Curie International PostDoc (2012-0064). Funding Information: We thank Drs. Badara Samb and Martina Brostrom from the Joint United Nations Programme on HIV/AIDS (UNAIDS), Geneva, Switzerland, for their critical review and advises on this manuscript. Dr. Nachega receives research grant support from the National Institutes of Health/National Institutes for Allergy and Infectious Disease, the AIDS Clinical Trial Group (ACTG)/Stellenbosch University Clinical Trial Unit (2UM1AI069521-08); the US President Emergency Plan for AIDS Relief (PEPFAR; T84HA21652-01-00) for Medical Education Partnership Initiative; the Stellenbosch University Collaborative Capacity Enhancement through Engagement with Districts (SUCCEED; 1 U2GGH001536-01); and the Wellcome Trust Southern Africa Consortium for Research Excellence (WT087537MA). Dr. Altice is funded by the National Institutes on Drug Abuse for Research (R01-DA 10186; R01-DA 13805; R01-DA 017072). Dr. Uthman acknowledges support from the FAS Marie Curie International PostDoc (2012-0064). Publisher Copyright: © 2016, Springer Science+Business Media New York.

PY - 2016/10/1

Y1 - 2016/10/1

N2 - 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.

AB - 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.

KW - ART

KW - Adherence

KW - Community

KW - Interventions

KW - LMIC

KW - Retention

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DO - 10.1007/s11904-016-0325-9

M3 - Review article

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Nachega JB, Adetokunboh O, Uthman OA, Knowlton AW, Altice FL, Schechter M et al. 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. Current HIV/AIDS Reports. 2016 Oct 1;13(5):241-255. doi: 10.1007/s11904-016-0325-9

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

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