Zachariah R, Teck R, Buhendwa L, Fitzerland M, Labana S, Chinji C, et al. Community support is associated with better antiretroviral treatment outcomes in a resource-limited rural district in Malawi

Médecins Sans Frontières, Medical Department (Operational Research), Brussels Operational Center, 68 Rue de Gasperich, L-1617, Luxembourg, Belgium.
Transactions of the Royal Society of Tropical Medicine and Hygiene (Impact Factor: 1.84). 01/2007; 101(1):79-84. DOI: 10.1016/j.trstmh.2006.05.010
Source: PubMed


A study was carried in a rural district in Malawi among HIV-positive individuals placed on antiretroviral treatment (ART) in order to verify if community support influences ART outcomes. Standardized ART outcomes in areas of the district with and without community support were compared. Between April 2003 (when ART was started) and December 2004 a total of 1634 individuals had been placed on ART. Eight hundred and ninety-five (55%) individuals were offered community support, while 739 received no such support. For all patients placed on ART with and without community support, those who were alive and continuing ART were 96 and 76%, respectively (P<0.001); death was 3.5 and 15.5% (P<0.001); loss to follow-up was 0.1 and 5.2% (P<0.001); and stopped ART was 0.8 and 3.3% (P<0.001). The relative risks (with 95% CI) for alive and on ART [1.26 (1.21-1.32)], death [0.22 (0.15-0.33)], loss to follow-up [0.02 (0-0.12)] and stopped ART [0.23 (0.08-0.54)] were all significantly better in those offered community support (P<0.001). Community support is associated with a considerably lower death rate and better overall ART outcomes. The community might be an unrecognized and largely 'unexploited resource' that could play an important contributory role in countries desperately trying to scale up ART with limited resources.

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    • "In terms of HIV=AIDS, CHWs have been effective in long-term adherence to highly antiretroviral therapy (HAART) and in maintaining quality of life among PLWHA (Zachariah et al., 2007). In rural Rwanda, CHWs have maintained high retention (92%) in care and improved viral loads among HIV-infected patients (Rich et al., 2012). "
    Journal of HIV/AIDS & Social Services 10/2014; 13(4):330-336. DOI:10.1080/15381501.2014.964536
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    • "Similarly, lack of food to eat before taking medication and inability to pay for transportation to clinics are known causes of defaulting TB treatment [16]. In agreement with previous studies [27], [28], CCWs have a major influence on treatment adherence and clinic visits. Alarmingly, our findings suggest that such facilitation is partly established through the use of private resources of CCWs. "
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    ABSTRACT: Although home-based care (HBC) programs are widely implemented throughout Africa, their success depends on the existence of an enabling environment, including a referral system and supply of essential commodities. The objective of this study was to explore the current state of client referral patterns and practices by community care workers (CCWs), in an evolving environment of one rural South African sub-district. Using a participant triangulation approach, in-depth qualitative interviews were conducted with 17 CCWs, 32 HBC clients and 32 primary caregivers (PCGs). An open-ended interview guide was used for data collection. Participants were selected from comprehensive lists of CCWs and their clients, using a diversified criterion-based sampling method. Three independent researchers coded three sets of data - CCWs, Clients and PCGs, for referral patterns and practices of CCWs. Referrals from clinics and hospitals to HBC occurred infrequently, as only eight (25%) of the 32 clients interviewed were formally referred. Community care workers showed high levels of commitment and personal investment in supporting their clients to use the formal health care system. They went to the extent of using their own personal resources. Seven CCWs used their own money to ensure client access to clinics, and eight gave their own food to ensure treatment adherence. Community care workers are essential in linking clients to clinics and hospitals and to promote the appropriate use of medical services, although this effort frequently necessitated consumption of their own personal resources. Therefore, risk protection strategies are urgently needed so as to ensure sustainability of the current work performed by HBC organizations and the CCW volunteers.
    PLoS ONE 04/2014; 9(4):e95324. DOI:10.1371/journal.pone.0095324 · 3.23 Impact Factor
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    • "This often comprises nonclinical, community-based services such as, but not limited to, spiritual, legal and economic support. While psychological care and support can come from staff at the health facility treating the patient, several studies have demonstrated that support is more effective when coming from a focused, on-going program in the community where the patient resides [6]-[9]. Just as support is needed for individual treatment adherence and retention in care, a re-evaluation of the entire health care system may be needed to ensure universal access to long-term care for HIV patients. "
    World Journal of AIDS 01/2014; 04(03):311-320. DOI:10.4236/wja.2014.43037
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