Journal Article

Effect of Peer Health Workers on AIDS Care in Rakai, Uganda: A Cluster-Randomized Trial

Reynolds, Steven J., Chang, Larry W., Bollinger, Robert C., Serwadda, David, Kagaayi, Joseph, Packer, Arnold H., Quinn, Thomas C., Gray, Ronald H., Nakigozi, Gertrude, Ssempijja, Victor

2010

Overview

Human resource limitations are a challenge to the delivery of antiretroviral therapy (ART) in low-resource settings. We conducted a cluster randomized trial to assess the effect of community-based peer health workers (PHW) on AIDS care of adults in Rakai, Uganda. 15 AIDS clinics were randomized 2:1 to receive the PHW intervention (n = 10) or control (n = 5). PHW tasks included clinic and home-based provision of counseling, clinical, adherence to ART, and social support. Primary outcomes were adherence and cumulative risk of virologic failure (>400 copies/mL). Secondary outcomes were virologic failure at each 24 week time point up to 192 weeks of ART. Analysis was by intention to treat. From May 2006 to July 2008, 1336 patients were followed. 444 (33%) of these patients were already on ART at the start of the study. No significant differences were found in lack of adherence (<95% pill count adherence risk ratio [RR] 0.55, 95% confidence interval [CI] 0.23-1.35; <100% adherence RR 1.10, 95% CI 0.94-1.30), cumulative risk of virologic failure (RR 0.81, 95% CI 0.61-1.08) or in shorter-term virologic outcomes (24 week virologic failure RR 0.93, 95% CI 0.65-1.32; 48 week, RR 0.83, 95% CI 0.47-1.48; 72 week, RR 0.81, 95% CI 0.44-1.49). However, virologic failure rates >or=96 weeks into ART were significantly decreased in the intervention arm compared to the control arm (96 week failure RR 0.50, 95% CI 0.31-0.81; 120 week, RR 0.59, 95% CI 0.22-1.60; 144 week, RR 0.39, 95% CI 0.16-0.95; 168 week, RR 0.30, 95% CI 0.097-0.92; 192 week, RR 0.067, 95% CI 0.0065-0.71). A PHW intervention was associated with decreased virologic failure rates occurring 96 weeks and longer into ART, but did not affect cumulative risk of virologic failure, adherence measures, or shorter-term virologic outcomes. PHWs may be an effective intervention to sustain long-term ART in low-resource settings. ClinicalTrials.gov NCT00675389.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Acquired immune deficiency syndrome / Acquired Immunodeficiency Syndrome - drug therapy / Adhesion / Adolescent / Adult / Adults / Aged / AIDS / AIDS (Disease) / Analysis / Anti-HIV Agents - administration & dosage / Anti-HIV Agents - therapeutic use / Antiretroviral agents / Antiretroviral drugs / Antiretroviral therapy / Biological products industry / Clinical trials / Cluster Analysis / Clusters / Confidence intervals / Failure rates / Female / Health Personnel / Highly active antiretroviral therapy / HIV / Human immunodeficiency virus / Humans / Infectious Diseases/HIV Infection and AIDS / Intervention / Male / Medical personnel / Middle Aged / Motivation / Patient Compliance / Patients / Peer Group / Physicians / Public Health and Epidemiology/Global Health / Public Health and Epidemiology/Infectious Diseases / Risk / Social aspects / Social interactions / Studies / Uganda / Viral Load / Workers / Young Adult