Effectiveness of patient adherence groups as a model of care for stable patients on antiretroviral therapy in Khayelitsha, Cape Town, South Africa

 

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dc.contributor.author Luque-Fernandez, Miguel Angel en_ZA
dc.contributor.author Cutsem, Gilles Van en_ZA
dc.contributor.author Goemaere, Eric en_ZA
dc.contributor.author Hilderbrand, Katherine en_ZA
dc.contributor.author Schomaker, Michael en_ZA
dc.contributor.author Mantangana, Nompumelelo en_ZA
dc.contributor.author Mathee, Shaheed en_ZA
dc.contributor.author Dubula, Vuyiseka en_ZA
dc.contributor.author Ford, Nathan en_ZA
dc.contributor.author Hernán, Miguel A en_ZA
dc.date.accessioned 2015-11-16T04:09:40Z
dc.date.available 2015-11-16T04:09:40Z
dc.date.issued 2013 en_ZA
dc.identifier.citation Luque-Fernandez, M. A., Van Cutsem, G., Goemaere, E., Hilderbrand, K., Schomaker, M., Mantangana, N., ... & Boulle, A. (2013). Effectiveness of patient adherence groups as a model of care for stable patients on antiretroviral therapy in Khayelitsha, Cape Town, South Africa. PLoS One, 8(2), e56088. doi:10.1371/journal.pone.0056088 en_ZA
dc.identifier.uri http://hdl.handle.net/11427/15004
dc.identifier.uri http://dx.doi.org/10.1371/journal.pone.0056088
dc.description.abstract BACKGROUND: Innovative models of care are required to cope with the ever-increasing number of patients on antiretroviral therapy in the most affected countries. This study, in Khayelitsha, South Africa, evaluates the effectiveness of a group-based model of care run predominantly by non-clinical staff in retaining patients in care and maintaining adherence. Methods and FINDINGS: Participation in "adherence clubs" was offered to adults who had been on ART for at least 18 months, had a current CD4 count >200 cells/ml and were virologically suppressed. Embedded in an ongoing cohort study, we compared loss to care and virologic rebound in patients receiving the intervention with patients attending routine nurse-led care from November 2007 to February 2011. We used inverse probability weighting to estimate the intention-to-treat effect of adherence club participation, adjusted for measured baseline and time-varying confounders. The principal outcome was the combination of death or loss to follow-up. The secondary outcome was virologic rebound in patients who were virologically suppressed at study entry. Of 2829 patients on ART for >18 months with a CD4 count above 200 cells/µl, 502 accepted club participation. At the end of the study, 97% of club patients remained in care compared with 85% of other patients. In adjusted analyses club participation reduced loss-to-care by 57% (hazard ratio [HR] 0.43, 95% CI = 0.21-0.91) and virologic rebound in patients who were initially suppressed by 67% (HR 0.33, 95% CI = 0.16-0.67). DISCUSSION: Patient adherence groups were found to be an effective model for improving retention and documented virologic suppression for stable patients in long term ART care. Out-of-clinic group-based models facilitated by non-clinical staff are a promising approach to assist in the long-term management of people on ART in high burden low or middle-income settings. en_ZA
dc.language.iso eng en_ZA
dc.publisher Public Library of Science en_ZA
dc.rights This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. en_ZA
dc.rights.uri http://creativecommons.org/licenses/by/4.0 en_ZA
dc.source PLoS One en_ZA
dc.source.uri http://journals.plos.org/plosone en_ZA
dc.subject.other Antiretroviral therapy en_ZA
dc.subject.other Viral load en_ZA
dc.subject.other Death rates en_ZA
dc.subject.other Data management en_ZA
dc.subject.other Long-term care en_ZA
dc.subject.other Health services research en_ZA
dc.title Effectiveness of patient adherence groups as a model of care for stable patients on antiretroviral therapy in Khayelitsha, Cape Town, South Africa en_ZA
dc.type Journal Article en_ZA
dc.rights.holder © 2013 Luque-Fernandez et al en_ZA
uct.type.publication Research en_ZA
uct.type.resource Article en_ZA
dc.publisher.institution University of Cape Town
dc.publisher.faculty Faculty of Health Sciences en_ZA
dc.publisher.department Institute of Infectious Disease and Molecular Medicine en_ZA
uct.type.filetype Text
uct.type.filetype Image
dc.identifier.apacitation Luque-Fernandez, M. A., Cutsem, G. V., Goemaere, E., Hilderbrand, K., Schomaker, M., Mantangana, N., ... Hernán, M. A. (2013). Effectiveness of patient adherence groups as a model of care for stable patients on antiretroviral therapy in Khayelitsha, Cape Town, South Africa. <i>PLoS One</i>, http://hdl.handle.net/11427/15004 en_ZA
dc.identifier.chicagocitation Luque-Fernandez, Miguel Angel, Gilles Van Cutsem, Eric Goemaere, Katherine Hilderbrand, Michael Schomaker, Nompumelelo Mantangana, Shaheed Mathee, Vuyiseka Dubula, Nathan Ford, and Miguel A Hernán "Effectiveness of patient adherence groups as a model of care for stable patients on antiretroviral therapy in Khayelitsha, Cape Town, South Africa." <i>PLoS One</i> (2013) http://hdl.handle.net/11427/15004 en_ZA
dc.identifier.vancouvercitation Luque-Fernandez MA, Cutsem GV, Goemaere E, Hilderbrand K, Schomaker M, Mantangana N, et al. Effectiveness of patient adherence groups as a model of care for stable patients on antiretroviral therapy in Khayelitsha, Cape Town, South Africa. PLoS One. 2013; http://hdl.handle.net/11427/15004. en_ZA
dc.identifier.ris TY - Journal Article AU - Luque-Fernandez, Miguel Angel AU - Cutsem, Gilles Van AU - Goemaere, Eric AU - Hilderbrand, Katherine AU - Schomaker, Michael AU - Mantangana, Nompumelelo AU - Mathee, Shaheed AU - Dubula, Vuyiseka AU - Ford, Nathan AU - Hernán, Miguel A AB - BACKGROUND: Innovative models of care are required to cope with the ever-increasing number of patients on antiretroviral therapy in the most affected countries. This study, in Khayelitsha, South Africa, evaluates the effectiveness of a group-based model of care run predominantly by non-clinical staff in retaining patients in care and maintaining adherence. Methods and FINDINGS: Participation in "adherence clubs" was offered to adults who had been on ART for at least 18 months, had a current CD4 count >200 cells/ml and were virologically suppressed. Embedded in an ongoing cohort study, we compared loss to care and virologic rebound in patients receiving the intervention with patients attending routine nurse-led care from November 2007 to February 2011. We used inverse probability weighting to estimate the intention-to-treat effect of adherence club participation, adjusted for measured baseline and time-varying confounders. The principal outcome was the combination of death or loss to follow-up. The secondary outcome was virologic rebound in patients who were virologically suppressed at study entry. Of 2829 patients on ART for >18 months with a CD4 count above 200 cells/µl, 502 accepted club participation. At the end of the study, 97% of club patients remained in care compared with 85% of other patients. In adjusted analyses club participation reduced loss-to-care by 57% (hazard ratio [HR] 0.43, 95% CI = 0.21-0.91) and virologic rebound in patients who were initially suppressed by 67% (HR 0.33, 95% CI = 0.16-0.67). DISCUSSION: Patient adherence groups were found to be an effective model for improving retention and documented virologic suppression for stable patients in long term ART care. Out-of-clinic group-based models facilitated by non-clinical staff are a promising approach to assist in the long-term management of people on ART in high burden low or middle-income settings. DA - 2013 DB - OpenUCT DO - 10.1371/journal.pone.0056088 DP - University of Cape Town J1 - PLoS One LK - https://open.uct.ac.za PB - University of Cape Town PY - 2013 T1 - Effectiveness of patient adherence groups as a model of care for stable patients on antiretroviral therapy in Khayelitsha, Cape Town, South Africa TI - Effectiveness of patient adherence groups as a model of care for stable patients on antiretroviral therapy in Khayelitsha, Cape Town, South Africa UR - http://hdl.handle.net/11427/15004 ER - en_ZA


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This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Except where otherwise noted, this item's license is described as This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.