Amsterdam 2015
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| Abstract #2254 - Treatment adherence | ||||
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Session: 48.2: Treatment adherence (Parallel) on Friday @ 09.00-10.30 in C002 Chaired by Kendra Blackett Dabinga, Aoife Molloy Authors: Presenting Author: Dr Geoffrey Fatti - KhethImpilo, South Africa |
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| Additional Authors: | ||||
| Aim: Sustaining high levels of patient retention and virological suppression over long durations of treatment has been a challenge for antiretroviral therapy (ART) programs in sub-Saharan Africa, the region having the highest burden of HIV globally. Community-based adherence support (CBAS) programs have been established to provide home-based adherence and psychosocial support for ART patients. However, there is little evidence of their longer-term impact. This study compared ART outcomes amongst patients with and without CBAS up to eight years of ART. | ||||
| Method / Issue: CBAS workers are clinic-linked lay healthcare personnel who provide regular adherence and psychosocial support for patients and undertake home visits to address household challenges affecting adherence. Family and household members are also assessed, and issues are discussed at clinic multidisciplinary team meetings. A multicentre cohort study using routinely collected clinical data was conducted at public ART sites in a high HIV prevalence province of South Africa. ART-naïve adults starting ART between 2004 and 2013 were included. The effect of CBAS on patient retention, mortality, loss to follow-up (LTFU) and virological suppression after starting ART was analysed using Kaplan-Meier, Cox and competing risks regression, and logistic regression. | ||||
| Results / Comments: 3861 patients were included, of whom 1616 (41.9%) received CBAS. At baseline, patients who received CBAS had a higher proportion who had advanced World Health Organization clinical stage (III or IV) disease (48.6% vs. 38.6% amongst patients who received and did not receive CBAS, respectively P<0.0001). The total observation time was 14,792 patient-years. After 8 years of ART, patient retention amongst patients with and without CBAS was 61.8% and 56.8%, respectively (P<0.0001). After controlling for confounding, overall patient attrition was reduced by 25% amongst patients who received CBAS, adjusted hazard ratio=0.75 (95% CI: 0.66-0.86). Loss to follow up was reduced by 26% amongst patients who received CBAS, adjusted subhazard ratio=0.74 (95% CI: 0.66-0.84). Amongst patients on ART for seven or more years, virological suppression was 87.0% and 75.0% in patients who received and did not receive CBAS, respectively (P=0.045). After controlling for confounding, the risk of having an unsuppressed viral load in patients on ART for 7 years or more was substantially lower amongst patients who received CBAS adjusted odds ratio=0.37 (95% CI: 0.15-0.91). | ||||
| Discussion: ART patients who received CBAS had improved patient retention and virological suppression over eight years of ART. CBAS is an intervention that can improve longer-term ART program outcomes in resource limited settings. | ||||
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