Availability of Volunteer-Led Home-Based Care System and Baseline Factors as Predictors of Clinical Outcomes in HIV-Infected Patients in Rural ZambiaReport as inadecuate




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Background

We assessed the impact of home-based care HBC for HIV+ patients, comparing outcomes between two groups of Zambians receiving antiretroviral therapy ART who lived in villages with and without HBC teams.

Methods

We conducted a retrospective cohort study using medical charts from Macha Mission Hospital, a hospital providing HIV care in Zambia-s rural Southern Province. Date of birth, date of ART initiation, place of residence, sex, body mass index BMI, CD4+ cell count, and hemoglobin Hgb were abstracted. Logistic regression was used to test our hypothesis that HBC was associated with treatment outcomes.

Results

Of 655 patients, 523 80% were eligible and included in the study. There were 428 patients 82% with favorable outcomes alive and on ART and 95 patients 18% with unfavorable outcomes died, lost to follow-up, or stopped treatment. A minority of the 523 eligible patients n = 84, 16% lived in villages with HBC available. Living in a village with HBC was not significantly associated with treatment outcomes; 80% of patients in a village with HBC had favorable outcomes, compared to 82% of patients in a village without HBC P = 0.6 by χ2. In bivariable analysis, lower BMI P<0.001, low CD4+ cell count P = 0.02, low Hgb concentration P = 0.02, and older age at ART initiation P = 0.047 were associated with unfavorable outcomes. In multivariable analysis, low BMI remained associated with unfavorable outcomes P<0.001.

Conclusions

We did not find that living in a village with HBC available was associated with improved treatment outcomes. We speculate that the ART clinic-s rigorous treatment preparation before ART initiation and continuous adherence counseling during ART create a motivated group of patients whose outcomes did not improve with additional HBC support. An alternative explanation is that the quality of the HBC program is suboptimal.



Author: Christopher B. Estopinal , Janneke H. van Dijk, Stanley Sitali, Hannah Stewart, Mario A. Davidson, John Spurrier, Sten H. Vermund

Source: http://plos.srce.hr/



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