A novel home-based AIDS care programme can achieve good adherence and response to antiretroviral therapy in a rural African setting, according to an Article in this week's issue of The Lancet.
Access to antiretroviral therapy is expanding in resource-limited settings but transport costs prevent many of those in need from getting to health facilities to receive treatment. Paul Weidle and colleagues from the Centers for Disease Control and Prevention in the USA assessed the effectiveness of a home-based approach to AIDS care in rural Uganda. The programme uses trained lay people who regularly visit participants at home to deliver medication and to collect information about adherence to antiretroviral therapy and possible toxic effects.
Over 980 adults who had received no previous antiretroviral therapy were enrolled into the study between July 2003 and May 2004. The researchers found that the majority of patients had good adherence to antiretroviral therapy and that this was associated with sustained suppression of HIV during the first year of treatment.
Dr Weidle concludes: "In Uganda, where the majority of HIV-infected people reside in rural areas and families live on less than US$1/day per person, transportation costs can pose an important barrier to adherence success. Home delivery of antiretroviral therapy could reduce this barrier, although direct weekly delivery to clients' homes might not be achievable in all settings. Home delivery might be more feasible on a monthly or quarterly basis, which would reduce costs substantially and allow a single field officer to cover between 100 and 300 participants."
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Contact: Office of Communications, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention. T) 404-639-8895
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