Home-Based Care Could Significantly Reduce Mortality Among HIV-Positive Adults, Families In Developing Countries, Study Says

The implementation of home-based care could significantly reduce mortality among adults living with HIV/AIDS in developing countries, as well as children within their families, according to a study published in the Feb. 28 issue of the journal Lancet, BBC News reports (BBC News, 2/29).

For the study, Jonathan Mermin of CDC's office in Nairobi, Kenya, and colleagues examined a group of HIV-positive people and their families in rural Uganda through three phases of treatment from 2001 to 2006 (AFP/Yahoo! News, 2/29). The team employed a network of paid staff with no clinical training to visit study participants weekly in their homes. The staff re-supplied participants' medications and documented any side effects, BBC News reports. People enrolled in the study were not required to visit a clinic (BBC News, 2/29).

During the study's first phase, researchers provided counseling, diarrhea prevention and hygiene education to 466 HIV-positive adults and 1,481 households with no HIV-positive members over the course of five months. The second phase involved administering a daily dose of antibiotics to the HIV-positive participants to prevent infections that could compromise their immune systems. In the third phase, researchers enrolled 138 HIV-positive adults from the original group, as well as 907 new HIV-positive people and their households, in an antiretroviral study. The study used the antiretrovirals lamivudine, stavudine and nevirapine, as well as three types of reverse transcriptase inhibitors.

Findings
During the first 16 weeks of combined antiretroviral and antibiotic treatment, mortality among the HIV-positive participants was 55% less compared with those who received the antibiotic alone, the study found. In addition, the combination resulted in a 95% decrease in mortality compared with no intervention at all, according to the researchers (AFP/Yahoo! News, 2/29). The study also found that the number of orphans decreased by 93% and that deaths among children younger than age 10 decreased by 81%, Reuters reports. In addition, the home visits led to a large decrease in deaths among HIV-negative children, which showed that providing antiretrovirals benefits the entire family, Mermin said.

Comments
Mermin said that the "results were achieved even though no routine clinic visits were scheduled after initial enrollment, and home visits were provided by trained lay providers." Although treatment is becoming more widely available in sub-Saharan Africa, patients still require constant monitoring and need to learn how to follow medication instructions, Mermin said, adding that it can be difficult for people who live long distances from clinics. "We wanted to find a way where people could avoid going to the health clinic," he said (Kahn, Reuters, 2/28). The authors concluded, "Wide provision of antiretroviral treatment and care in sub-Saharan Africa could have a profound effect on prevention of mortality in people with HIV, improve the health and longevity of their children, and reduce the rate of orphanhood."














According to BBC News, the researchers acknowledged the study likely scheduled more home visits than would be provided by most African health care systems. Eline Korenromp and Jane Kengeya Kayondo of the Global Fund To Fight AIDS, Tuberculosis and Malaria said that this factor is an "important limitation," adding, "At least two-thirds of patients received better care than can presently be expected in most African antiretroviral treatment programs." Korenromp and Kayondo suggested that the study be expanded with less frequent visits. Ade Fakoya, an adviser to the International HIV/AIDS Alliance, said, "Getting HIV treatment to people who live in rural areas is difficult, and this could have an impact." She added, "This is affordable and could be carried out on a larger scale. And if you keep the parents healthy, you also keep their children healthy" (BBC News, 2/29).


The study abstract is available online.


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