Task-shifting of antiretroviral delivery from health care workers to persons living with HIV/AIDS: Clinical outcomes of a community-based program in Kenya

Henry M. Selke, Sylvester Kimaiyo, John Sidle, Rajesh Vedanthan, William M. Tierney, Changyu Shen, Cheryl D. Denski, Adrian R. Katschke, Kara Wools-Kaloustian

Research output: Contribution to journalArticle

133 Citations (Scopus)

Abstract

Objectives: To assess whether community-based care delivered by people living with HIV/AIDS (PLWAs) could replace clinic-based HIV care. Design: Prospective cluster randomized controlled clinical trial. Setting: Villages surrounding 1 rural clinic in western Kenya. Subjects: HIV-infected adults clinically stable on antiretroviral therapy (ART). Intervention: The intervention group received monthly Personal Digital Assistant supported home assessments by PLWAs with clinic appointments every 3 months. The control group received standard of care monthly clinic visits. Main outcomes measured: Viral load, CD4 count, Karnofsky score, stability of ART regimen, opportunistic infections, pregnancies, and number of clinic visits. Results: After 1 year, there were no significant intervention-control differences with regard to detectable viral load, mean CD4 count, decline in Karnofsky score, change in ART regimen, new opportunistic infection, or pregnancy rate. Intervention patients made half as many clinic visits as did controls (P < 0.001). Conclusions: Community-based care by PLWAs resulted in similar clinical outcomes as usual care but with half the number of clinic visits. This pilot study suggests that task-shifting and mobile technologies can deliver safe and effective community-based care to PLWAs, expediting ART rollout and increasing access to treatment while expanding the capacity of health care institutions in resource-constrained environments.

Original languageEnglish
Pages (from-to)483-490
Number of pages8
JournalJournal of Acquired Immune Deficiency Syndromes
Volume55
Issue number4
DOIs
StatePublished - Dec 1 2010

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Kenya
Acquired Immunodeficiency Syndrome
HIV
Ambulatory Care
Delivery of Health Care
Opportunistic Infections
CD4 Lymphocyte Count
Viral Load
Handheld Computers
Therapeutics
Pregnancy Rate
Standard of Care
Appointments and Schedules
Randomized Controlled Trials
Technology
Pregnancy
Control Groups

Keywords

  • antiretroviral therapy
  • health information technology
  • healthcare delivery
  • HIV/AIDS
  • sub-Saharan Africa
  • task-shifting

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

Cite this

Task-shifting of antiretroviral delivery from health care workers to persons living with HIV/AIDS : Clinical outcomes of a community-based program in Kenya. / Selke, Henry M.; Kimaiyo, Sylvester; Sidle, John; Vedanthan, Rajesh; Tierney, William M.; Shen, Changyu; Denski, Cheryl D.; Katschke, Adrian R.; Wools-Kaloustian, Kara.

In: Journal of Acquired Immune Deficiency Syndromes, Vol. 55, No. 4, 01.12.2010, p. 483-490.

Research output: Contribution to journalArticle

Selke, Henry M. ; Kimaiyo, Sylvester ; Sidle, John ; Vedanthan, Rajesh ; Tierney, William M. ; Shen, Changyu ; Denski, Cheryl D. ; Katschke, Adrian R. ; Wools-Kaloustian, Kara. / Task-shifting of antiretroviral delivery from health care workers to persons living with HIV/AIDS : Clinical outcomes of a community-based program in Kenya. In: Journal of Acquired Immune Deficiency Syndromes. 2010 ; Vol. 55, No. 4. pp. 483-490.
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