Excellent clinical outcomes and high retention in care among adults in a community-based HIV treatment program in rural Rwanda
Rich, M.L.; Miller, A.C.; Niyigena, P.; Franke, M.F.; Niyonzima, J.Bosco.; Socci, A.; Drobac, P.C.; Hakizamungu, M.; Mayfield, A.; Ruhayisha, R.; Epino, H.; Stulac, S.; Cancedda, C.; Karamaga, A.; Niyonzima, S.; Yarbrough, C.; Fleming, J.; Amoroso, C.; Mukherjee, J.; Murray, M.; Farmer, P.; Binagwaho, A.
Journal of Acquired Immune Deficiency Syndromes 59(3): E35-E42
2012
ISSN/ISBN: 1525-4135 PMID: 22156912 DOI: 10.1097/qai.0b013e31824476c4Document Number: 552742
Access to antiretroviral therapy (ART) has rapidly expanded; as of the end of 2010, an estimated 6.6 million people are receiving ART in low-income and middle-income countries. Few reports have focused on the experiences of rural health centers or the use of community health workers. We report clinical and programatic outcomes at 24 months for a cohort of patients enrolled in a community-based ART program in southeastern Rwanda under collaboration between Partners In Health and the Rwandan Ministry of Health. A retrospective medical record review was performed for a cohort of 1041 HIV+ adult patients initiating community-based ART between June 1, 2005, and April 30, 2006. Key programatic elements included free ART with direct observation by community health worker, tuberculosis screening and treatment, nutritional support, a transportation allowance, and social support. Among 1041 patients who initiated community-based ART, 961 (92.3%) were retained in care, 52 (5%) died and 28 (2.7%) were lost to follow-up. Median CD4 T-cell count increase was 336 cells per microliter [interquartile range: (IQR): 212-493] from median 190 cells per microliter (IQR: 116-270) at initiation. A program of intensive community-based treatment support for ART in rural Rwanda had excellent outcomes in 24-month retention in care. Having committed to improving access to HIV treatment in sub-Saharan Africa, the international community, including country HIV programs, should set high programmatic outcome benchmarks.