Availability of Volunteer-Led Home-Based Care System and Baseline Factors as Predictors of Clinical Outcomes in HIV-Infected Patients in Rural Zambia.docVIP

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Availability of Volunteer-Led Home-Based Care System and Baseline Factors as Predictors of Clinical Outcomes in HIV-Infected Patients in Rural Zambia.doc

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Availability of Volunteer-Led Home-Based Care System and Baseline Factors as Predictors of Clinical Outcomes in HIV-Infected Patients in Rural Zambia

AvailabilityofVolunteer-LedHome-BasedCareSystem andBaselineFactorsasPredictorsofClinicalOutcomes inHIV-InfectedPatientsinRuralZambia ChristopherB.Estopinal1*,JannekeH.vanDijk2,StanleySitali3,HannahStewart2,MarioA.Davidson1, JohnSpurrier3,StenH.Vermund1 1VanderbiltUniversitySchoolofMedicine,Nashville,Tennessee,UnitedStatesofAmerica,2MachaResearchTrust,Macha,Zambia,3MachaMissionHospital,Macha, Zambia Abstract Background: We assessed the impact of home-based care (HBC) for HIV+ patients, comparing outcomes between two groupsofZambiansreceivingantiretroviraltherapy(ART)wholivedinvillageswithandwithoutHBCteams. Methods: We conducted a retrospective cohort study using medical charts from Macha Mission Hospital, a hospital providingHIVcareinZambia’sruralSouthernProvince.Dateofbirth,dateofARTinitiation,placeofresidence,sex,body mass index (BMI), CD4+ cell count, and hemoglobin (Hgb) were abstracted. Logistic regression was used to test our hypothesisthatHBCwasassociatedwithtreatmentoutcomes. Results:Of655patients,523(80%)wereeligibleandincludedinthestudy.Therewere428patients(82%)withfavorable outcomes (alive and on ART) and 95 patients (18%) with unfavorable outcomes (died, lost to follow-up, or stopped treatment).Aminorityofthe523eligiblepatients(n=84,16%)livedinvillageswithHBCavailable.Livinginavillagewith HBC was not significantly associated with treatment outcomes; 80% of patients in a village with HBC had favorable 2 outcomes,comparedto82%ofpatientsinavillagewithoutHBC(P=0.6byx ).Inbivariableanalysis,lowerBMI(P,0.001), lowCD4+cellcount(P=0.02),lowHgbconcentration(P=0.02),andolderageatARTinitiation(P=0.047)wereassociated withunfavorableoutcomes.Inmultivariableanalysis,lowBMIremainedassociatedwithunfavorableoutcomes(P,0.001). Conclusions:WedidnotfindthatlivinginavillagewithHBCavailablewasassociatedwithimprovedtreatmentoutcomes. We speculate that the ART clinic’s rigorous treatment preparation before ART initiation and continuous adherence counselingduringARTcreat