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

Simple item page
dc.contributor.authorLuque-Fernandez, Miguel Angelen_ZA
dc.contributor.authorCutsem, Gilles Vanen_ZA
dc.contributor.authorGoemaere, Ericen_ZA
dc.contributor.authorHilderbrand, Katherineen_ZA
dc.contributor.authorSchomaker, Michaelen_ZA
dc.contributor.authorMantangana, Nompumeleloen_ZA
dc.contributor.authorMathee, Shaheeden_ZA
dc.contributor.authorDubula, Vuyisekaen_ZA
dc.contributor.authorFord, Nathanen_ZA
dc.contributor.authorHernán, Miguel Aen_ZA
dc.date.accessioned2015-11-16T04:09:40Z
dc.date.available2015-11-16T04:09:40Z
dc.date.issued2013en_ZA
dc.description.abstractBACKGROUND: 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.identifier.apacitationLuque-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/11427/15004en_ZA
dc.identifier.chicagocitationLuque-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/11427/15004en_ZA
dc.identifier.citationLuque-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.0056088en_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
dc.identifier.urihttp://hdl.handle.net/11427/15004
dc.identifier.urihttp://dx.doi.org/10.1371/journal.pone.0056088
dc.identifier.vancouvercitationLuque-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.language.isoengen_ZA
dc.publisherPublic Library of Scienceen_ZA
dc.publisher.departmentInstitute of Infectious Disease and Molecular Medicineen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis 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.holder© 2013 Luque-Fernandez et alen_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/4.0en_ZA
dc.sourcePLoS Oneen_ZA
dc.source.urihttp://journals.plos.org/plosoneen_ZA
dc.subject.otherAntiretroviral therapyen_ZA
dc.subject.otherViral loaden_ZA
dc.subject.otherDeath ratesen_ZA
dc.subject.otherData managementen_ZA
dc.subject.otherLong-term careen_ZA
dc.subject.otherHealth services researchen_ZA
dc.titleEffectiveness of patient adherence groups as a model of care for stable patients on antiretroviral therapy in Khayelitsha, Cape Town, South Africaen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
Files
Original bundle
Now showing 1 - 1 of 1
Thumbnail Image
Name:
Luque_Fernandez_Patient_Adherence_2013.pdf
Size:
303.99 KB
Format:
Adobe Portable Document Format
Description:
Download
Collections
Journal Articles