Availability of volunteer-led home-based care system and baseline factors as predictors of clinical outcomes in HIV-infected patients in rural Zambia.

<h4>Background</h4>We assessed the impact of home-based care (HBC) for HIV+ patients, comparing outcomes between two groups of Zambians receiving antiretroviral therapy (ART) who lived in villages with and without HBC teams.<h4>Methods</h4>We conducted a retrospective cohort...

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Autores principales:	Christopher B Estopinal, Janneke H van Dijk, Stanley Sitali, Hannah Stewart, Mario A Davidson, John Spurrier, Sten H Vermund
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2012
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/00a8fec2e5a6489bb07a6cd47269ef4d
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spelling	oai:doaj.org-article:00a8fec2e5a6489bb07a6cd47269ef4d2021-11-18T08:06:06ZAvailability of volunteer-led home-based care system and baseline factors as predictors of clinical outcomes in HIV-infected patients in rural Zambia.1932-620310.1371/journal.pone.0049564https://doaj.org/article/00a8fec2e5a6489bb07a6cd47269ef4d2012-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/23236351/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>We assessed the impact of home-based care (HBC) for HIV+ patients, comparing outcomes between two groups of Zambians receiving antiretroviral therapy (ART) who lived in villages with and without HBC teams.<h4>Methods</h4>We conducted a retrospective cohort study using medical charts from Macha Mission Hospital, a hospital providing HIV care in Zambia's rural Southern Province. Date of birth, date of ART initiation, place of residence, sex, body mass index (BMI), CD4+ cell count, and hemoglobin (Hgb) were abstracted. Logistic regression was used to test our hypothesis that HBC was associated with treatment outcomes.<h4>Results</h4>Of 655 patients, 523 (80%) were eligible and included in the study. There were 428 patients (82%) with favorable outcomes (alive and on ART) and 95 patients (18%) with unfavorable outcomes (died, lost to follow-up, or stopped treatment). A minority of the 523 eligible patients (n = 84, 16%) lived in villages with HBC available. Living in a village with HBC was not significantly associated with treatment outcomes; 80% of patients in a village with HBC had favorable outcomes, compared to 82% of patients in a village without HBC (P = 0.6 by χ(2)). In bivariable analysis, lower BMI (P<0.001), low CD4+ cell count (P = 0.02), low Hgb concentration (P = 0.02), and older age at ART initiation (P = 0.047) were associated with unfavorable outcomes. In multivariable analysis, low BMI remained associated with unfavorable outcomes (P<0.001).<h4>Conclusions</h4>We did not find that living in a village with HBC available was associated with improved treatment outcomes. We speculate that the ART clinic's rigorous treatment preparation before ART initiation and continuous adherence counseling during ART create a motivated group of patients whose outcomes did not improve with additional HBC support. An alternative explanation is that the quality of the HBC program is suboptimal.Christopher B EstopinalJanneke H van DijkStanley SitaliHannah StewartMario A DavidsonJohn SpurrierSten H VermundPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 7, Iss 12, p e49564 (2012)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Christopher B Estopinal Janneke H van Dijk Stanley Sitali Hannah Stewart Mario A Davidson John Spurrier Sten H Vermund Availability of volunteer-led home-based care system and baseline factors as predictors of clinical outcomes in HIV-infected patients in rural Zambia.
description	<h4>Background</h4>We assessed the impact of home-based care (HBC) for HIV+ patients, comparing outcomes between two groups of Zambians receiving antiretroviral therapy (ART) who lived in villages with and without HBC teams.<h4>Methods</h4>We conducted a retrospective cohort study using medical charts from Macha Mission Hospital, a hospital providing HIV care in Zambia's rural Southern Province. Date of birth, date of ART initiation, place of residence, sex, body mass index (BMI), CD4+ cell count, and hemoglobin (Hgb) were abstracted. Logistic regression was used to test our hypothesis that HBC was associated with treatment outcomes.<h4>Results</h4>Of 655 patients, 523 (80%) were eligible and included in the study. There were 428 patients (82%) with favorable outcomes (alive and on ART) and 95 patients (18%) with unfavorable outcomes (died, lost to follow-up, or stopped treatment). A minority of the 523 eligible patients (n = 84, 16%) lived in villages with HBC available. Living in a village with HBC was not significantly associated with treatment outcomes; 80% of patients in a village with HBC had favorable outcomes, compared to 82% of patients in a village without HBC (P = 0.6 by χ(2)). In bivariable analysis, lower BMI (P<0.001), low CD4+ cell count (P = 0.02), low Hgb concentration (P = 0.02), and older age at ART initiation (P = 0.047) were associated with unfavorable outcomes. In multivariable analysis, low BMI remained associated with unfavorable outcomes (P<0.001).<h4>Conclusions</h4>We did not find that living in a village with HBC available was associated with improved treatment outcomes. We speculate that the ART clinic's rigorous treatment preparation before ART initiation and continuous adherence counseling during ART create a motivated group of patients whose outcomes did not improve with additional HBC support. An alternative explanation is that the quality of the HBC program is suboptimal.
format	article
author	Christopher B Estopinal Janneke H van Dijk Stanley Sitali Hannah Stewart Mario A Davidson John Spurrier Sten H Vermund
author_facet	Christopher B Estopinal Janneke H van Dijk Stanley Sitali Hannah Stewart Mario A Davidson John Spurrier Sten H Vermund
author_sort	Christopher B Estopinal
title	Availability of volunteer-led home-based care system and baseline factors as predictors of clinical outcomes in HIV-infected patients in rural Zambia.
title_short	Availability of volunteer-led home-based care system and baseline factors as predictors of clinical outcomes in HIV-infected patients in rural Zambia.
title_full	Availability of volunteer-led home-based care system and baseline factors as predictors of clinical outcomes in HIV-infected patients in rural Zambia.
title_fullStr	Availability of volunteer-led home-based care system and baseline factors as predictors of clinical outcomes in HIV-infected patients in rural Zambia.
title_full_unstemmed	Availability of volunteer-led home-based care system and baseline factors as predictors of clinical outcomes in HIV-infected patients in rural Zambia.
title_sort	availability of volunteer-led home-based care system and baseline factors as predictors of clinical outcomes in hiv-infected patients in rural zambia.
publisher	Public Library of Science (PLoS)
publishDate	2012
url	https://doaj.org/article/00a8fec2e5a6489bb07a6cd47269ef4d
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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.

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