Delivery of Community-based Antiretroviral Therapy to Maintain Viral Suppression and Retention in Care in South Africa.
Journal
Journal of acquired immune deficiency syndromes (1999)
ISSN: 1944-7884
Titre abrégé: J Acquir Immune Defic Syndr
Pays: United States
ID NLM: 100892005
Informations de publication
Date de publication:
01 06 2023
01 06 2023
Historique:
received:
05
07
2022
accepted:
04
01
2023
medline:
26
6
2023
pubmed:
17
2
2023
entrez:
16
2
2023
Statut:
ppublish
Résumé
To determine whether the Centralized Chronic Medication Dispensing and Distribution (CCMDD) program in South Africa's differentiated ART delivery model affects clinical outcomes, we assessed viral load (VL) suppression and retention in care between patients participating in the program and those receiving the clinic-based standard of care. Clinically stable people living with HIV (PLHIV) eligible for differentiated care were referred to the national CCMDD program and followed up for up to 6 months. In this secondary analysis of trial cohort data, we estimated the association between routine patient participation in the CCMDD program and their clinical outcomes of viral suppression (<200 copies/mL) and retention in care. Among 390 PLHIV, 236 (61%) were assessed for CCMDD eligibility; 144 (37%) were eligible, and 116 (30%) participated in the CCMDD program. Participants obtained their ART in a timely manner at 93% (265/286) of CCMDD visits. VL suppression and retention in care was very similar among CCMDD-eligible patients who participated in the program compared with patients who did not participate in the program (aRR: 1.03; 95% CI: 0.94-1.12). VL suppression alone (aRR: 1.02; 95% CI: 0.97-1.08) and retention in care alone (aRR: 1.03; 95% CI: 0.95-1.12) were also similar between CCMDD-eligible PLHIV who participated in the program and those who did not. The CCMDD program successfully facilitated differentiated care among clinically stable participants. PLHIV participating in the CCMDD program maintained a high proportion of viral suppression and retention in care, indicating that community-based ART delivery model did not negatively affect their HIV care outcomes.
Sections du résumé
BACKGROUND
To determine whether the Centralized Chronic Medication Dispensing and Distribution (CCMDD) program in South Africa's differentiated ART delivery model affects clinical outcomes, we assessed viral load (VL) suppression and retention in care between patients participating in the program and those receiving the clinic-based standard of care.
METHODS
Clinically stable people living with HIV (PLHIV) eligible for differentiated care were referred to the national CCMDD program and followed up for up to 6 months. In this secondary analysis of trial cohort data, we estimated the association between routine patient participation in the CCMDD program and their clinical outcomes of viral suppression (<200 copies/mL) and retention in care.
RESULTS
Among 390 PLHIV, 236 (61%) were assessed for CCMDD eligibility; 144 (37%) were eligible, and 116 (30%) participated in the CCMDD program. Participants obtained their ART in a timely manner at 93% (265/286) of CCMDD visits. VL suppression and retention in care was very similar among CCMDD-eligible patients who participated in the program compared with patients who did not participate in the program (aRR: 1.03; 95% CI: 0.94-1.12). VL suppression alone (aRR: 1.02; 95% CI: 0.97-1.08) and retention in care alone (aRR: 1.03; 95% CI: 0.95-1.12) were also similar between CCMDD-eligible PLHIV who participated in the program and those who did not.
CONCLUSION
The CCMDD program successfully facilitated differentiated care among clinically stable participants. PLHIV participating in the CCMDD program maintained a high proportion of viral suppression and retention in care, indicating that community-based ART delivery model did not negatively affect their HIV care outcomes.
Identifiants
pubmed: 36796353
doi: 10.1097/QAI.0000000000003176
pii: 00126334-990000000-00192
pmc: PMC7614548
mid: EMS170887
doi:
Substances chimiques
Anti-HIV Agents
0
Banques de données
ClinicalTrials.gov
['NCT03066128']
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
126-133Subventions
Organisme : Wellcome Trust
Pays : United Kingdom
Organisme : Wellcome Trust
ID : 216421
Pays : United Kingdom
Organisme : NIAID NIH HHS
ID : P30 AI027757
Pays : United States
Organisme : NIAID NIH HHS
ID : R21 AI124719
Pays : United States
Informations de copyright
Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
Références
Lancet HIV. 2022 Jan;9(1):e13-e23
pubmed: 34843674
AIDS Res Ther. 2019 Aug 12;16(1):17
pubmed: 31405386
Curr HIV/AIDS Rep. 2019 Aug;16(4):324-334
pubmed: 31230342
BMJ Open. 2020 May 15;10(5):e035412
pubmed: 32414827
AIDS Care. 2018 Aug;30(8):1010-1016
pubmed: 29471667
J Int AIDS Soc. 2017 Jul 21;20(Suppl 4):21644
pubmed: 28770589
BMJ Open. 2017 Sep 27;7(9):e017507
pubmed: 28963304
BMJ Open. 2021 Oct 5;11(10):e050116
pubmed: 34610939
Bull World Health Organ. 2017 Jan 1;95(1):3
pubmed: 28053356
J Int AIDS Soc. 2017 Nov;20(3):
pubmed: 29178197
BMC Public Health. 2020 Jul 24;20(1):1158
pubmed: 32709228
J Int AIDS Soc. 2017 Jul 21;20(Suppl 4):21636
pubmed: 28770593
MMWR Morb Mortal Wkly Rep. 2015 Nov 27;64(46):1287-90
pubmed: 26605986
AIDS. 2019 Dec 15;33 Suppl 3:S213-S226
pubmed: 31490781
BMC Health Serv Res. 2021 May 17;21(1):463
pubmed: 34001123
AIDS Care. 2018 Dec;30(12):1477-1487
pubmed: 30037312
J Acquir Immune Defic Syndr. 2019 Aug 15;81(5):540-546
pubmed: 31021988
J Int AIDS Soc. 2017 Jul 21;20(Suppl 4):21654
pubmed: 28770590
J Int AIDS Soc. 2017 Jul 21;20(Suppl 4):21650
pubmed: 28770594
J Int AIDS Soc. 2017 Jul 21;20(Suppl 4):22024
pubmed: 28770588
Health Policy Plan. 2019 Mar 1;34(2):110-119
pubmed: 30789208
PLoS Med. 2019 May 21;16(5):e1002808
pubmed: 31112543