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Public-sector ART in the Free State Province, South Africa: Community support as an important determinant of outcome

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  • Wouters, Edwin
  • Van Damme, Wim
  • Van Loon, Francis
  • van Rensburg, Dingie
  • Meulemans, Herman

Abstract

The treatment outcomes for large-scale public antiretroviral therapy (ART) programs in developing countries, although promising, are still preliminary. The scaling-up of ART in resource-limited settings is inevitably hampered by human resource shortages. Therefore, community support for ART patients may play an important role in achieving favorable treatment outcomes. This study aimed to extend the current literature by investigating how immunological and virological responses to ART, measured at three points in time (after six, 12, and 24 months of ART), are influenced by patient characteristics (age, sex), health literacy (educational level and knowledge about HIV/AIDS), baseline CD4 cell count, baseline viral load, and three forms of community support (treatment buddy, community health worker [CHW], and HIV/AIDS support group). Cross-lagged regression analysis was used to test these relationships in a sample of 268 patients enrolled in the public-sector ART program of the Free State Province of South Africa (2004-2007). After 24 months of ART, 76.4% of patients were classified as treatment successes (viral load = 200 cells/[mu]L), compared with 64.1% at 12 months and 46.1% at six months. When we examined the predictors of ART success, baseline health and all three community support initiatives had a positive effect on ART outcomes after six months, whereas patient characteristics had little effect. Six months later, patients with the support of a treatment buddy, CHW, or support group had better ART outcomes, whereas the impact of baseline health had diminished. After two years of treatment, community support again emerged as the most important predictor of treatment success. This study confirms that the ART provided by South African public-sector health services is effective. These results provide evidence from the field that communities can be mobilized to sustain these favorable outcomes under conditions of limited human resources for healthcare.

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  • Wouters, Edwin & Van Damme, Wim & Van Loon, Francis & van Rensburg, Dingie & Meulemans, Herman, 2009. "Public-sector ART in the Free State Province, South Africa: Community support as an important determinant of outcome," Social Science & Medicine, Elsevier, vol. 69(8), pages 1177-1185, October.
    • Handle: RePEc:eee:socmed:v:69:y:2009:i:8:p:1177-1185
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    References listed on IDEAS

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    2. Fabien Taieb & Yoann Madec & Amandine Cournil & Eric Delaporte, 2017. "Virological success after 12 and 24 months of antiretroviral therapy in sub-Saharan Africa: Comparing results of trials, cohorts and cross-sectional studies using a systematic review and meta-analysis," PLOS ONE, Public Library of Science, vol. 12(4), pages 1-28, April.
    3. Ilona Sips & Ahmad Haeri Mazanderani & Helen Schneider & Minrie Greeff & Francoise Barten & Mosa Moshabela, 2014. "Community Care Workers, Poor Referral Networks and Consumption of Personal Resources in Rural South Africa," PLOS ONE, Public Library of Science, vol. 9(4), pages 1-7, April.
    4. Caroline Masquillier & Edwin Wouters & Dimitri Mortelmans & Brian Van Wyk, 2015. "On the Road to HIV/AIDS Competence in the Household: Building a Health-Enabling Environment for People Living with HIV/AIDS," IJERPH, MDPI, vol. 12(3), pages 1-29, March.
    5. Kerry E Uebel & Gina Joubert & Edwin Wouters & Willie F Mollentze & Dingie H C J van Rensburg, 2013. "Integrating HIV Care into Primary Care Services: Quantifying Progress of an Intervention in South Africa," PLOS ONE, Public Library of Science, vol. 8(1), pages 1-8, January.
    6. Mosa Moshabela & Shira Gitomer & Bongiwe Qhibi & Helen Schneider, 2013. "Development of Non-Profit Organisations Providing Health and Social Services in Rural South Africa: A Three-Year Longitudinal Study," PLOS ONE, Public Library of Science, vol. 8(12), pages 1-1, December.
    7. Tulloch, Olivia & Taegtmeyer, Miriam & Ananworanich, Jintanat & Chasombat, Sanchai & Kosalaraksa, Pope & Theobald, Sally, 2015. "What can volunteer co-providers contribute to health systems? The role of people living with HIV in the Thai paediatric HIV programme," Social Science & Medicine, Elsevier, vol. 145(C), pages 184-192.
    8. Boyer, Sylvie & Clerc, Isabelle & Bonono, Cécile-Renée & Marcellin, Fabienne & Bilé, Paule-Christiane & Ventelou, Bruno, 2011. "Non-adherence to antiretroviral treatment and unplanned treatment interruption among people living with HIV/AIDS in Cameroon: Individual and healthcare supply-related factors," Social Science & Medicine, Elsevier, vol. 72(8), pages 1383-1392, April.
    9. Helmut Beichler & Igor Grabovac & Thomas E. Dorner, 2023. "Integrated Care as a Model for Interprofessional Disease Management and the Benefits for People Living with HIV/AIDS," IJERPH, MDPI, vol. 20(4), pages 1-15, February.
    10. Robertson, Laura & Mushati, Phyllis & Skovdal, Morten & Eaton, Jeffrey W. & Makoni, Jeremiah C. & Crea, Tom & Mavise, Gideon & Dumba, Lovemore & Schumacher, Christina & Sherr, Lorraine & Nyamukapa, Co, 2014. "Involving Communities in the Targeting of Cash Transfer Programs for Vulnerable Children: Opportunities and Challenges," World Development, Elsevier, vol. 54(C), pages 325-337.

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