WEAE0204 - Oral Abstract
Community-based adherence support associated with improved virological suppression in adults receiving antiretroviral treatment: five-year outcomes from a multicentre cohort study in South Africa
Presented by Ashraf Grimwood (South Africa).
G. Fatti1, A. Grimwood1, J. Shea2
1Kheth'Impilo, Cape Town, South Africa, 2University of Cape Town, Child Health Unit, School of Child & Adolescent Health, Cape Town, South Africa
Background: Sub-Saharan African antiretroviral treatment (ART) programmes have a severe professional staff shortage resulting in inadequate support for patients which contributes to increasing virologic failure. However, community-based adherence-support (CBAS) workers now form a significant work-force. This study evaluated the effect of CBAS on virological outcomes at 57 non-governmental organization-supported public ART facilities in four South African provinces.
Methods: CBAS workers provide education and psychosocial support for ART patients through home visits to assess and address adherence challenges. A multicentre cohort study was performed, including adults starting ART between January 2004-September 2010 at clinics where patients were eligible to receive CBAS. Prospectively collected routine electronic data were analysed. Outcome measures were virological suppression (VS) (viral load < 400 copies/ml) at six-monthly intervals until 5 years of ART. Multivariable generalised estimating equations were used to compare VS between patients who received and not receiving CBAS, using an intention-to-treat approach. Extreme-case sensitivity analyses were performed to estimate bias due to missing viral load results.
Results: 66,953 patients were included: 19,668 (29.4%) received CBAS and 47,285 (70.6%) did not. At baseline, median age was 34.8 years; 45,844 (68.5%) were female; median CD4 cell count was 125 cells/µl (IQR: 65-175). After six months of ART, VS was 76.6% (95% CI: 75.8%-77.5%) and 72.0% (CI: 71.3%-72.5%) in CBAS patients and non-CBAS patients, respectively (P< 0.0001). In multivariable analyses after one and five years of ART, CBAS was associated with improved VS, adjusted odds ratio (aOR) 1.33 (CI: 1.24-1.43) and aOR 2.66 (CI: 1.61-4.40), respectively. Improved virological suppression in CBAS patients remained evident in sensitivity analyses considering missing test results as either suppressed (aOR 1.44 [CI: 1.37-1.52]) or unsuppressed (aOR 1.15 [CI: 1.11-1.19]).
Conclusions: CBAS was associated with improved virological suppression, the magnitude of which increased for longer therapy duration. Expanded implementation of this intervention should be considered in resource-poor settings.
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