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| Content Provider | World Health Organization (WHO)-Global Index Medicus |
|---|---|
| Author | Kyomuhangi, Rosette Namara, Geoffrey Foster, Susan Levin, Jonathan Tappero, Jordan W. Coutinho, Alex Ndembi, Nicaise Jaffar, Shabbar Birungi, Josephine Opio, Alex Bunnell, Rebecca Amuron, Barbara Nabiryo, Christine Grosskurth, Heiner Mermin, Jonathan |
| Spatial Coverage | Uganda |
| Description | Author Affiliation: Jaffar S ( Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK. shabbar.jaffar@lshtm.ac.uk) |
| Abstract | BACKGROUND: Identification of new ways to increase access to antiretroviral therapy in Africa is an urgent priority. We assessed whether home-based HIV care was as effective as was facility-based care. METHODS: We undertook a cluster-randomised equivalence trial in Jinja, Uganda. 44 geographical areas in nine strata, defined according to ratio of urban and rural participants and distance from the clinic, were randomised to home-based or facility-based care by drawing sealed cards from a box. The trial was integrated into normal service delivery. All patients with WHO stage IV or late stage III disease or CD4-cell counts fewer than 200 cells per microL who started antiretroviral therapy between Feb 15, 2005, and Dec 19, 2006, were eligible, apart from those living on islands. Follow-up continued until Jan 31, 2009. The primary endpoint was virological failure, defined as RNA more than 500 copies per mL after 6 months of treatment. The margin of equivalence was 9% (equivalence limits 0.69-1.45). Analyses were by intention to treat and adjusted for baseline CD4-cell count and study stratum. This trial is registered at http://isrctn.org, number ISRCTN 17184129. FINDINGS: 859 patients (22 clusters) were randomly assigned to home and 594 (22 clusters) to facility care. During the first year, 93 (11%) receiving home care and 66 (11%) receiving facility care died, 29 (3%) receiving home and 36 (6%) receiving facility care withdrew, and 8 (1%) receiving home and 9 (2%) receiving facility care were lost to follow-up. 117 of 729 (16%) in home care had virological failure versus 80 of 483 (17%) in facility care: rates per 100 person-years were 8.19 (95% CI 6.84-9.82) for home and 8.67 (6.96-10.79) for facility care (rate ratio [RR] 1.04, 0.78-1.40; equivalence shown). Two patients from each group were immediately lost to follow-up. Mortality rates were similar between groups (0.95 [0.71-1.28]). 97 of 857 (11%) patients in home and 75 of 592 (13%) in facility care were admitted at least once (0.91, 0.64-1.28). INTERPRETATION: This home-based HIV-care strategy is as effective as is a clinic-based strategy, and therefore could enable improved and equitable access to HIV treatment, especially in areas with poor infrastructure and access to clinic care. |
| ISSN | 01406736 |
| e-ISSN | 1474547X |
| Journal | The Lancet |
| Issue Number | 9707 |
| Volume Number | 374 |
| Language | English |
| Publisher | Elsevier |
| Publisher Date | 2009-12-19 |
| Publisher Place | Great Britain (UK) |
| Access Restriction | Open |
| Subject Keyword | Anti-HIV Agents Therapeutic Use Community Health Services HIV Infections Drug Therapy Home Care Services Adenine Analogs & Derivatives CD4 Lymphocyte Count HIV Isolation & Purification Virology Lamivudine Administration & Dosage Nevirapine Organophosphonates Stavudine Tenofovir Uganda Zidovudine Comparative Study Randomized Controlled Trial Research Support, Non-U.S. Gov't Research Support, U.S. Gov't, P.H.S. Medicine |
| Content Type | Text |
| Resource Type | Article |
| Subject | Medicine |
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