Grimsrud, A., Lesosky, M., Kalombo, C., et al. Journal of Acquired Immune Deficiency Syndromes (January 2016), 71(1):e16–e23, doi: 10.1097/QAI.0000000000000863.
This study described loss to follow-up (LTFU) and viral rebound (persistent detectable levels of HIV in the blood) in antiretroviral therapy (ART) among patients attending community-based adherence clubs (CACs) and compared these outcomes to those of patients managed in community health centers (CHC). The analysis included 8,150 adults initiating ART from 2002 to 2012 in a public-sector facility, who were followed until the end of 2013. CACs, led by a community health care worker and supported by a nurse, comprised groups of 25 to 30 patients. CACs met every two months for group counseling, a brief symptom screening, and distribution of ART. The authors reported that overall, 94 percent of CAC patients were retained on ART after 12 months, and patients in CACs were associated with a decreased risk of LTFU compared with those in CHCs, irrespective of age, sex, year of ART initiation, or CD4 cell count at ART initiation. The exception was for youth aged 16–24 years; in this group, risks of LTFU were similar between the CAC and CHC models. These findings, the authors said, point to the potential of community-based models of care contributing to the achievement of global treatment targets while supporting long-term retention in care.