Abstract:
Objective: To develop and assess an alternative care model using
community-based groups for people living with HIV and facilitate
by lay personnel.
Methods: Geographic locations in the Academic Model Providing
Access to Healthcare Kitale clinic catchment were randomized to
standard of care versus a community-based care group (ART Co-op).
Adults stable on antiretroviral therapy and virally suppressed were
eligible. Research Assistant–led ART Co-ops met in the community
every 3 months. Participants were seen in the HIV clinic only if
referred. CD4 count and viral load were measured in clinic at
enrollment and after 12 months. Retention, viral suppression, and
clinic utilization were compared between groups using x2, Fisher
exact, and Wilcoxon rank sum tests.
Results: At 12 months, there were no significant differences in
mean CD4 count or viral load suppression. There was a significant
difference in patient retention in assigned study group between the
intervention and control group (81.6% vs 98.6%; P , 0.001), with a
number of intervention patients withdrawing because of stigma,
relocation, pregnancy, and work conflicts. All participants, however,
were retained in an HIV care program for the study duration. The
median number of clinic visits was lower for the intervention group
than that for the control group (0 vs 3; P , 0.001).
Conclusions: Individuals retained in a community-based HIV care
model had clinical outcomes equivalent to those receiving clinic-
based care. This innovative model of HIV care addresses the
problems of insufficient health care personnel and patient retention
barriers, including time, distance, and cost to attend clinic, and has
the potential for wider implementation.
