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Effectiveness of Patient Adherence Groups as a Model of Care for Stable Patients on Antiretroviral Therapy in Khayelitsha, Cape Town, South Africa

Author

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  • Miguel Angel Luque-Fernandez
  • Gilles Van Cutsem
  • Eric Goemaere
  • Katherine Hilderbrand
  • Michael Schomaker
  • Nompumelelo Mantangana
  • Shaheed Mathee
  • Vuyiseka Dubula
  • Nathan Ford
  • Miguel A Hernán
  • Andrew Boulle

Abstract

Background: 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.

Suggested Citation

  • Miguel Angel Luque-Fernandez & Gilles Van Cutsem & Eric Goemaere & Katherine Hilderbrand & Michael Schomaker & Nompumelelo Mantangana & Shaheed Mathee & Vuyiseka Dubula & Nathan Ford & Miguel A Hernán, 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, Public Library of Science, vol. 8(2), pages 1-8, February.
    • Handle: RePEc:plo:pone00:0056088
    DOI: 10.1371/journal.pone.0056088
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    References listed on IDEAS

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    1. Zoe Fewell & Frederick Wolfe & Hyon Choi & Miguel A. Hernán & Kate Tilling & Jonathan A. C. Sterne, 2004. "Controlling for time-dependent confounding using marginal structural models," Stata Journal, StataCorp LP, vol. 4(4), pages 402-420, December.
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