IDEAS home Printed from https://ideas.repec.org/a/plo/pone00/0056088.html
   My bibliography  Save this article

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

Author

Listed:
  • 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
    as

    Download full text from publisher

    File URL: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0056088
    Download Restriction: no
    File URL: https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0056088&type=printable
    Download Restriction: no
    File URL: https://libkey.io/10.1371/journal.pone.0056088?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    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.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Allison Milner & Yamna Taouk & George Disney & Zoe Aitken & Jerome Rachele & Anne Kavanagh, 2018. "Employment predictors of exit from work among workers with disabilities: A survival analysis from the household income labour dynamics in Australia survey," PLOS ONE, Public Library of Science, vol. 13(12), pages 1-14, December.
    2. Erica Moodie & D. Stephens, 2011. "Marginal Structural Models: unbiased estimation for longitudinal studies," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 56(1), pages 117-119, February.
    3. Nam Kyoon N. Kim & Simon C. Parker, 0. "Entrepreneurial homeworkers," Small Business Economics, Springer, vol. 0, pages 1-25.
    4. Nam Kyoon N. Kim & Simon C. Parker, 2021. "Entrepreneurial homeworkers," Small Business Economics, Springer, vol. 57(3), pages 1427-1451, October.
    5. Matteo Prato & Fabrizio Ferraro, 2018. "Starstruck: How Hiring High-Status Employees Affects Incumbents’ Performance," Organization Science, INFORMS, vol. 29(5), pages 755-774, October.
    6. Do, D. Phuong & Wang, Lu & Elliott, Michael R., 2013. "Investigating the relationship between neighborhood poverty and mortality risk: A marginal structural modeling approach," Social Science & Medicine, Elsevier, vol. 91(C), pages 58-66.
    7. Xiao, Jing, 2018. "Post-acquisition dynamics of technology start-ups: drawing the temporal boundaries of post-acquisition restructuring process," Papers in Innovation Studies 2018/12, Lund University, CIRCLE - Centre for Innovation Research.
    8. Geraldine A. Wu, 2012. "The Effect of Going Public on Innovative Productivity and Exploratory Search," Organization Science, INFORMS, vol. 23(4), pages 928-950, August.
    9. Jing Xiao, 2015. "The effects of acquisition on the growth of new technology-based firms: Do different types of acquirers matter?," Small Business Economics, Springer, vol. 45(3), pages 487-504, October.
    10. Buenstorf, Guido, 2009. "Is commercialization good or bad for science? Individual-level evidence from the Max Planck Society," Research Policy, Elsevier, vol. 38(2), pages 281-292, March.
    11. Raffoul, Amanda & Beccia, Ariel L. & Jackson, Destiny A. & Sarda, Vishnudas & Hart, Jaime E. & Chavarro, Jorge E. & Austin, S. Bryn, 2023. "Associations between weight discrimination and the use of potentially harmful dietary supplements during the COVID-19 pandemic in the United States," Social Science & Medicine, Elsevier, vol. 335(C).
    12. Elena Pirani & Silvana Salvini, 2014. "Is temporary employment damaging to health? A longitudinal study on Italian workers," Econometrics Working Papers Archive 2014_08, Universita' degli Studi di Firenze, Dipartimento di Statistica, Informatica, Applicazioni "G. Parenti".
    13. Yana Kucheva, 2014. "The Receipt of Subsidized Housing across Generations," Population Research and Policy Review, Springer;Southern Demographic Association (SDA), vol. 33(6), pages 841-871, December.
    14. Mudrazija, Stipica & Butrica, Barbara A., 2023. "How does debt shape health outcomes for older Americans?," Social Science & Medicine, Elsevier, vol. 329(C).
    15. Li, Ang & Baker, Emma & Bentley, Rebecca, 2022. "Understanding the mental health effects of instability in the private rental sector: A longitudinal analysis of a national cohort," Social Science & Medicine, Elsevier, vol. 296(C).
    16. Yana Kucheva, 2018. "Subsidized Housing and the Transition to Adulthood," Demography, Springer;Population Association of America (PAA), vol. 55(2), pages 617-642, April.
    17. Pirani, Elena & Salvini, Silvana, 2015. "Is temporary employment damaging to health? A longitudinal study on Italian workers," Social Science & Medicine, Elsevier, vol. 124(C), pages 121-131.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:plo:pone00:0056088. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: plosone (email available below). General contact details of provider: https://journals.plos.org/plosone/ .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.