Home-Based Antiretroviral Care Is Associated With Positive Social Outcomes in a Prospective Cohort in Uganda

Apondi, Rose; Bunnell, Rebecca; Awor, Anna; Wamai, Nafuna; Bikaako-Kajura, Winifred; Solberg, Peter; Stall, Ron; Coutinho, Alex; Mermin, Jonathan

doi:10.1097/01.qai.0000243113.29412.dd

Cited by 65 publications

(37 citation statements)

References 19 publications

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“…In contrast, a woman in Uganda reported a decrease in her husband’s IPV perpetration as his illness progressed, though not when they both tested positive for HIV [96]: “She thought their illness would improve the relationship, but it did not. The main change came after the man began falling sick and lost energy, “after a while he was weak and did not have the energy to beat me.”” IPV did not significantly increase with initiation of home-based ART in a study of women with HIV in Uganda [13]; rates of physical IPV were 1% (3/459) in the three months before ART initiation and 2% (9/436) in the three months after program initiation, with an unadjusted OR of 3.20 (95% CI 0.94-10.9, p=0.063), though notably, 5 (1%) of the 436 women reported physical violence associated with program participation.…”

Section: Resultsmentioning

confidence: 99%

A Systematic Review of the Relationships between Intimate Partner Violence and HIV/AIDS

et al. 2013

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BackgroundIntimate partner violence (IPV) is a significant health problem that has been associated with HIV infection in numerous studies. We aimed to systematically review the literature on relationships between IPV and HIV in order to describe the prevalence of IPV in people with HIV, the prevalence of HIV in people experiencing IPV, the association between IPV and HIV, and evidence regarding mechanisms of risk and interventions.MethodsData sources were 10 electronic databases and reference lists. Studies were included if they reported data on the relationship between IPV and HIV. All records were independently reviewed by two authors at the stages of title and abstract review and full text review. Any abstract considered eligible by either reviewer was reviewed in full, and any disagreement regarding eligibility of full texts or data extracted was resolved by discussion. Results101 articles were included. Experiencing IPV and HIV infection were associated in unadjusted analyses in most studies, as well as in adjusted analyses in many studies. The findings of qualitative and quantitative studies assessing potential mechanisms linking IPV and HIV were variable. Few interventions have been assessed, but two identified in this review were promising in terms of preventing IPV, though not HIV infection.ConclusionsExperiencing IPV and HIV infection tend to be associated in unadjusted analyses, suggesting that IPV screening and linkage with relevant programs and services may be valuable. It is unclear whether there is a causal association between experiencing IPV and HIV infection. Research should focus on defining parameters of IPV which are relevant to HIV infection, including type of IPV and period of exposure and risk, on assessing potential mechanisms, and on developing and assessing interventions which build on the strengths of existing studies.

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Section: Resultsmentioning

confidence: 99%

A Systematic Review of the Relationships between Intimate Partner Violence and HIV/AIDS

et al. 2013

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“…In terms of stigma, an RCT reported that only 3 % of patients refused to participate in the home-based ART program due to stigma [25]. Furthermore, it has even been suggested that involvement of community-health care workers in HIV care reduced stigma [72] and being part of peer groups has been found to decrease the perception of social stigma [73]. …”

Section: Discussionmentioning

confidence: 99%

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

et al. 2016

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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.

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“…A growing body of evidence suggests that novel strategies to bring HIV services to the community level through task shifting, such as home-based HIV testing [52]–[55] and home-based ART initiation [56] and delivery [57]–[61] are effective, feasible and acceptable [62]. In addition, positive side effects of home-based ART delivery programs include increased community-level social support and decreased discrimination [61], [63], and clients of these services reported saving time and money due to reduced clinic visits [64]. These novel community-based strategies would require significant political commitment and operational research to tailor programs to the local context, but may have the potential to strengthen all stages of the HIV care continuum by improving identification of HIV-infected individuals, simplifying linkages to care, improving retention in ART care programs, and reducing structural-level barriers such as distance, cost and stigma and discrimination.…”

Section: Discussionmentioning

confidence: 99%

Multi-Level Factors Affecting Entry into and Engagement in the HIV Continuum of Care in Iringa, Tanzania

et al. 2014

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Progression through the HIV continuum of care, from HIV testing to lifelong retention in antiretroviral therapy (ART) care and treatment programs, is critical to the success of HIV treatment and prevention efforts. However, significant losses occur at each stage of the continuum and little is known about contextual factors contributing to disengagement at these stages. This study sought to explore multi-level barriers and facilitators influencing entry into and engagement in the continuum of care in Iringa, Tanzania. We used a mixed-methods study design including facility-based assessments and interviews with providers and clients of HIV testing and treatment services; interviews, focus group discussions and observations with community-based providers and clients of HIV care and support services; and longitudinal interviews with men and women living with HIV to understand their trajectories in care. Data were analyzed using narrative analysis to identify key themes across levels and stages in the continuum of care. Participants identified multiple compounding barriers to progression through the continuum of care at the individual, facility, community and structural levels. Key barriers included the reluctance to engage in HIV services while healthy, rigid clinic policies, disrespectful treatment from service providers, stock-outs of supplies, stigma and discrimination, alternate healing systems, distance to health facilities and poverty. Social support from family, friends or support groups, home-based care providers, income generating opportunities and community mobilization activities facilitated engagement throughout the HIV continuum. Findings highlight the complex, multi-dimensional dynamics that individuals experience throughout the continuum of care and underscore the importance of a holistic and multi-level perspective to understand this process. Addressing barriers at each level is important to promoting increased engagement throughout the continuum.

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Home-Based Antiretroviral Care Is Associated With Positive Social Outcomes in a Prospective Cohort in Uganda

Abstract: Participation in a home-based antiretroviral therapy program was associated with multiple positive social outcomes.

Cited by 65 publications

References 19 publications

A Systematic Review of the Relationships between Intimate Partner Violence and HIV/AIDS

A Systematic Review of the Relationships between Intimate Partner Violence and HIV/AIDS

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

Multi-Level Factors Affecting Entry into and Engagement in the HIV Continuum of Care in Iringa, Tanzania

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