Excellent Clinical Outcomes and High Retention in Care Among Adults in a Community-Based HIV Treatment Program in Rural Rwanda

TLDR

ART coverage has expanded rapidly, reaching 6.6 million people worldwide, yet few studies examine rural health centers or community health worker roles. The study reports 24‑month clinical and programmatic outcomes of 1,041 adults in a community‑based ART program in southeastern Rwanda, and argues that the international community should set high outcome benchmarks. The program provided free ART with community health worker–directed adherence support, TB screening and treatment, nutrition, transportation allowance, and social support, and data were collected via a retrospective medical record review of 1,041 patients. At 24 months, 92.3 % of patients were retained, 5 % died, 2.7 % were lost to follow‑up, and median CD4 counts rose by 336 cells/µL.

Abstract

Access to antiretroviral therapy (ART) has rapidly expanded; as of the end of 2010, an estimated 6.6 million people are receiving ART in low-income and middle-income countries. Few reports have focused on the experiences of rural health centers or the use of community health workers. We report clinical and programatic outcomes at 24 months for a cohort of patients enrolled in a community-based ART program in southeastern Rwanda under collaboration between Partners In Health and the Rwandan Ministry of Health.A retrospective medical record review was performed for a cohort of 1041 HIV+ adult patients initiating community-based ART between June 1, 2005, and April 30, 2006. Key programatic elements included free ART with direct observation by community health worker, tuberculosis screening and treatment, nutritional support, a transportation allowance, and social support. Among 1041 patients who initiated community-based ART, 961 (92.3%) were retained in care, 52 (5%) died and 28 (2.7%) were lost to follow-up. Median CD4 T-cell count increase was 336 cells per microliter [interquartile range: (IQR): 212-493] from median 190 cells per microliter (IQR: 116-270) at initiation.A program of intensive community-based treatment support for ART in rural Rwanda had excellent outcomes in 24-month retention in care. Having committed to improving access to HIV treatment in sub-Saharan Africa, the international community, including country HIV programs, should set high programmatic outcome benchmarks.