Home based HIV care just as effective as clinic based care in sub-Saharan Africa
20 July 2009
Lay workers who are trained to deliver anti-retroviral therapy (ART) to people with HIV in their own homes are as effective as healthcare workers based in clinics. This is the finding of the Jinja trial, announced on 20 July at the International AIDS Society conference in Cape Town, South Africa.
In sub-Saharan Africa, urban hospitals currently provide the majority of HIV care. A shortage of trained medical staff and the difficult journey many patients face to attend make it difficult for the clinics to provide consistent care.
The trial was designed to assess whether trained field officers who do not have a medical qualification, could deliver ART to the homes of patients; monitor patients for drug side-effects or disease progression; and support patients to encourage adherence to ART.
Throughout the trial, patients given ART in this way were invited for periodic clinical review by a doctor at a clinic and also asked to attend any time they felt unwell. The home-based strategy was compared with a standard model in which care (including drug dispensing) was delivered from a clinic using mostly medically trained staff. Allocation to the model of care was random. In total, 1,453 people enrolled in the trial, 859 on home-based care and 594 on the clinic-based care.
Home-based care with trained lay workers was found to be as effective as nurse- and doctor-led clinic-based care. Outcomes for patients were as good as or better than those reported in most other African cohorts. Delivery of ART through the home-based care model was no more expensive than centralised clinic-based delivery, and was actually a few dollars cheaper per patient each month (US$66 compared to US$70). The costs to the patient of accessing ART were considerably less for those receiving home-based care; mean annual costs totalled US$6 compared to US$30 for those attending the clinic.
Dr Shabbar Jaffar of the London School of Hygiene and Tropical Medicine said:
‘‘This trial has shown that trained lay-workers can play a major role in delivering HIV services cost-effectively, and without compromising patient safety. More research is now needed both to inform how to provide community-based care on a larger scale, to determine how families, rather than individuals, might be targeted, and to investigate the feasibility of combining HIV care with that of other conditions requiring long-term care, such as tuberculosis and cardiovascular disease.’’
Scientists from the London School of Hygiene and Tropical Medicine, the UK Medical Research Council/Uganda Virus Research Institute, the AIDS Support Organisation (TASO), the Centre for Disease Control and Prevention in Uganda and the Ministry of Health of Uganda, collaborated to run the trial.
Coordination was provided by the TASO clinic in Jinja, South East Uganda. Patients were cared for by TASO staff and patient management was in accordance with national guidelines.
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