Public-sector ART in the Free State Province, South Africa: community support as an important determinant of outcome.
Identifieur interne : 001A16 ( PubMed/Checkpoint ); précédent : 001A15; suivant : 001A17Public-sector ART in the Free State Province, South Africa: community support as an important determinant of outcome.
Auteurs : Edwin Wouters [Belgique] ; Wim Van Damme ; Francis Van Loon ; Dingie Van Rensburg ; Herman MeulemansSource :
- Social science & medicine (1982) [ 1873-5347 ] ; 2009.
Descripteurs français
- KwdFr :
- Adulte, Analyse de régression, Antirétroviraux (usage thérapeutique), Caractéristiques de l'habitat, Connaissances, attitudes et pratiques en santé, Entretiens comme sujet, Facteurs socioéconomiques, Femelle, Humains, Infections à VIH (traitement médicamenteux), Mise au point de programmes (), Mâle, Pays en voie de développement, République d'Afrique du Sud, Résultat thérapeutique, Secteur public, Soutien social, Études de cohortes, Évaluation de programme.
- MESH :
- traitement médicamenteux : Infections à VIH.
- usage thérapeutique : Antirétroviraux.
- Adulte, Analyse de régression, Caractéristiques de l'habitat, Connaissances, attitudes et pratiques en santé, Entretiens comme sujet, Facteurs socioéconomiques, Femelle, Humains, Mise au point de programmes, Mâle, Pays en voie de développement, République d'Afrique du Sud, Résultat thérapeutique, Secteur public, Soutien social, Études de cohortes, Évaluation de programme.
- Wicri :
- geographic : Afrique du Sud.
English descriptors
- KwdEn :
- Adult, Anti-Retroviral Agents (therapeutic use), Cohort Studies, Developing Countries, Female, HIV Infections (drug therapy), Health Knowledge, Attitudes, Practice, Humans, Interviews as Topic, Male, Program Development (methods), Program Evaluation, Public Sector, Regression Analysis, Residence Characteristics, Social Support, Socioeconomic Factors, South Africa, Treatment Outcome.
- MESH :
- chemical , therapeutic use : Anti-Retroviral Agents.
- geographic : South Africa.
- drug therapy : HIV Infections.
- methods : Program Development.
- Adult, Cohort Studies, Developing Countries, Female, Health Knowledge, Attitudes, Practice, Humans, Interviews as Topic, Male, Program Evaluation, Public Sector, Regression Analysis, Residence Characteristics, Social Support, Socioeconomic Factors, Treatment Outcome.
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 < 400 copies/mL, CD4 > or = 200 cells/microL), 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.
DOI: 10.1016/j.socscimed.2009.07.034
PubMed: 19692165
Affiliations:
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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 < 400 copies/mL, CD4 > or = 200 cells/microL), 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. 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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 < 400 copies/mL, CD4 > or = 200 cells/microL), 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. 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PubStatus="pubmed"><Year>2009</Year><Month>8</Month><Day>21</Day><Hour>9</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2009</Year><Month>10</Month><Day>30</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">19692165</ArticleId><ArticleId IdType="pii">S0277-9536(09)00491-2</ArticleId><ArticleId IdType="doi">10.1016/j.socscimed.2009.07.034</ArticleId></ArticleIdList></PubmedData></pubmed><affiliations><list><country><li>Belgique</li></country><region><li>Province d'Anvers</li><li>Région flamande</li></region><settlement><li>Anvers</li></settlement><orgName><li>Université d'Anvers</li></orgName></list><tree><noCountry><name sortKey="Meulemans, Herman" sort="Meulemans, Herman" uniqKey="Meulemans H" first="Herman" last="Meulemans">Herman Meulemans</name><name sortKey="Van Damme, Wim" sort="Van Damme, Wim" uniqKey="Van Damme W" first="Wim" last="Van Damme">Wim Van Damme</name><name sortKey="Van Loon, Francis" sort="Van Loon, Francis" uniqKey="Van Loon F" first="Francis" last="Van Loon">Francis Van Loon</name><name sortKey="Van Rensburg, Dingie" sort="Van Rensburg, Dingie" uniqKey="Van Rensburg D" first="Dingie" last="Van Rensburg">Dingie Van Rensburg</name></noCountry><country name="Belgique"><region name="Région flamande"><name sortKey="Wouters, Edwin" sort="Wouters, Edwin" uniqKey="Wouters E" first="Edwin" last="Wouters">Edwin Wouters</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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