Chang L.W., Alamo S., Guma S., Christopher J., Suntoke T., Omasete R., Montis J.P., Quinn T.C., Juncker M., Reynolds S.J.
Division of Infectious Diseases, Johns Hopkins Medical Institutions, 1830 East Monument Street, Baltimore, MD 21287, United States; Reach Out Mbuya Parish HIV/AIDS Initiative, Kampala, Uganda; National Institute for Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
Chang, L.W., Division of Infectious Diseases, Johns Hopkins Medical Institutions, 1830 East Monument Street, Baltimore, MD 21287, United States; Alamo, S., Reach Out Mbuya Parish HIV/AIDS Initiative, Kampala, Uganda; Guma, S., Reach Out Mbuya Parish HIV/AIDS Initiative, Kampala, Uganda; Christopher, J., Reach Out Mbuya Parish HIV/AIDS Initiative, Kampala, Uganda; Suntoke, T., National Institute for Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States; Omasete, R., Reach Out Mbuya Parish HIV/AIDS Initiative, Kampala, Uganda; Montis, J.P., Reach Out Mbuya Parish HIV/AIDS Initiative, Kampala, Uganda; Quinn, T.C., Division of Infectious Diseases, Johns Hopkins Medical Institutions, 1830 East Monument Street, Baltimore, MD 21287, United States, National Institute for Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States; Juncker, M., Reach Out Mbuya Parish HIV/AIDS Initiative, Kampala, Uganda; Reynolds, S.J., Division of Infectious Diseases, Johns Hopkins Medical Institutions, 1830 East Monument Street, Baltimore, MD 21287, United States, National Institute for Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
BACKGROUND: There is growing concern about the human resources needed to care for increasing numbers of patients receiving antiretroviral therapy in resource-limited settings. We evaluated an alternative model, community-based, comprehensive antiretroviral program staffed primarily by peer health workers and nurses. METHODS: We conducted a retrospective cohort study of patients receiving antiretroviral therapy during the first 10 months of program enrollment beginning in late 2003. Virologic, immunologic, clinical, and adherence data were collected. RESULTS: Of 360 patients started on treatment, 258 (72%) were active and on therapy approximately 2 years later. Viral load testing demonstrated that 86% of active patients (211/246 tested) had a viral load <400 copies per milliliter. The median CD4 increase for active patients was 197 cells per cubic millimeter (interquartile range, 108-346). Patients with either a history of antiretroviral use or lack of CD4 response were more likely to experience virologic failure. Survival was 84% at 1 year and 82% at 2 years. World Health Organization stage 4 was predictive of both not sustaining therapy and increased mortality. CONCLUSIONS: A community-based antiretroviral treatment program in a resource-limited setting can provide excellent AIDS care over at least a 2-year period. A comprehensive program based upon peer health workers and nurses provides an effective alternative model for AIDS care. © 2009 Lippincott Williams & Wilkins.