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dc.contributor.authorLuque-Fernandez, Miguel Angel
dc.contributor.authorVan Cutsem, Gilles
dc.contributor.authorGoemaere, Eric
dc.contributor.authorHilderbrand, Katherine
dc.contributor.authorSchomaker, Michael
dc.contributor.authorMantangana, Nompumelelo
dc.contributor.authorMathee, Shaheed
dc.contributor.authorDubula, Vuyiseka
dc.contributor.authorFord, Nathan
dc.contributor.authorBoulle, Andrew
dc.contributor.authorHernan, Miguel Angel
dc.date.accessioned2013-09-14T15:19:47Z
dc.date.issued2013
dc.identifier.citationLuque-Fernandez, Miguel Angel, Gilles Van Cutsem, Eric Goemaere, Katherine Hilderbrand, Michael Schomaker, Nompumelelo Mantangana, Shaheed Mathee, et al. 2013. Effectiveness of patient adherence groups as a model of care for stable patients on antiretroviral therapy in Khayelitsha, Cape Town, South Africa. PLoS ONE 8(2): e56088.en_US
dc.identifier.issn1932-6203en_US
dc.identifier.urihttp://nrs.harvard.edu/urn-3:HUL.InstRepos:11029506
dc.description.abstractBackground: Innovative models of care are required to cope with the ever-increasing number of patients on antiretroviral therapy in the most affected countries. This study, in Khayelitsha, South Africa, evaluates the effectiveness of a group-based model of care run predominantly by non-clinical staff in retaining patients in care and maintaining adherence. Methods and Findings: Participation in “adherence clubs” was offered to adults who had been on ART for at least 18 months, had a current CD4 count >200 cells/ml and were virologically suppressed. Embedded in an ongoing cohort study, we compared loss to care and virologic rebound in patients receiving the intervention with patients attending routine nurse-led care from November 2007 to February 2011. We used inverse probability weighting to estimate the intention-to-treat effect of adherence club participation, adjusted for measured baseline and time-varying confounders. The principal outcome was the combination of death or loss to follow-up. The secondary outcome was virologic rebound in patients who were virologically suppressed at study entry. Of 2829 patients on ART for >18 months with a CD4 count above 200 cells/µl, 502 accepted club participation. At the end of the study, 97% of club patients remained in care compared with 85% of other patients. In adjusted analyses club participation reduced loss-to-care by 57% (hazard ratio [HR] 0.43, 95% CI = 0.21–0.91) and virologic rebound in patients who were initially suppressed by 67% (HR 0.33, 95% CI = 0.16–0.67). Discussion Patient adherence groups were found to be an effective model for improving retention and documented virologic suppression for stable patients in long term ART care. Out-of-clinic group-based models facilitated by non-clinical staff are a promising approach to assist in the long-term management of people on ART in high burden low or middle-income settings.en_US
dc.language.isoen_USen_US
dc.publisherPublic Library of Scienceen_US
dc.relation.isversionofdoi:10.1371/journal.pone.0056088en_US
dc.relation.hasversionhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC3571960/pdf/en_US
dash.licenseLAA
dc.subjectBiologyen_US
dc.subjectMicrobiologyen_US
dc.subjectVirologyen_US
dc.subjectAntiviralsen_US
dc.subjectMathematicsen_US
dc.subjectStatisticsen_US
dc.subjectMedicineen_US
dc.subjectClinical Research Designen_US
dc.subjectCohort Studiesen_US
dc.subjectEpidemiologyen_US
dc.subjectInfectious Disease Epidemiologyen_US
dc.subjectGlobal Healthen_US
dc.subjectInfectious Diseasesen_US
dc.subjectViral Diseasesen_US
dc.subjectHIVen_US
dc.subjectHIV epidemiologyen_US
dc.subjectRetrovirology and HIV immunopathogenesisen_US
dc.subjectInfectious Disease Controlen_US
dc.subjectNon-Clinical Medicineen_US
dc.subjectHealth Care Policyen_US
dc.subjectHealth Systems Strengtheningen_US
dc.subjectQuality of Careen_US
dc.subjectHealth Care Providersen_US
dc.subjectNursesen_US
dc.subjectHealth Care Qualityen_US
dc.subjectHealth Services Researchen_US
dc.subjectMedical Practice Managementen_US
dc.subjectMedical Sociologyen_US
dc.subjectPatient Advocacyen_US
dc.subjectNursing Scienceen_US
dc.subjectNursing Administrationen_US
dc.subjectPrimary Careen_US
dc.subjectPublic Healthen_US
dc.subjectPreventive Medicineen_US
dc.subjectSocioeconomic Aspects of Healthen_US
dc.subjectSocial and Behavioral Sciencesen_US
dc.subjectEconomicsen_US
dc.subjectOperations Researchen_US
dc.titleEffectiveness of Patient Adherence Groups as a Model of Care for Stable Patients on Antiretroviral Therapy in Khayelitsha, Cape Town, South Africaen_US
dc.typeJournal Articleen_US
dc.description.versionVersion of Recorden_US
dc.relation.journalPLoS ONEen_US
dash.depositing.authorHernan, Miguel Angel
dc.date.available2013-09-14T15:19:47Z
dc.identifier.doi10.1371/journal.pone.0056088*
dash.authorsorderedfalse
dash.contributor.affiliatedHernan, Miguel


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