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Home-Based Antiretroviral Care Is Associated With Positive Social Outcomes in a Prospective Cohort in Uganda

Apondi, Rose BA*; Bunnell, Rebecca ScDMed*; Awor, Anna MStat*; Wamai, Nafuna MBChB, MPH*; Bikaako-Kajura, Winifred MPAM*; Solberg, Peter MD; Stall, Ron D PhD; Coutinho, Alex MBChB, MSc§; Mermin, Jonathan MD, MPH*

JAIDS Journal of Acquired Immune Deficiency Syndromes: January 1st, 2007 - Volume 44 - Issue 1 - p 71-76
doi: 10.1097/01.qai.0000243113.29412.dd
Epidemiology and Social Science

Background: Home-based antiretroviral therapy (ART) care in Africa has expanded; but social outcomes of home-based ART programs are unknown.

Methods: Social experiences of participants in an antiretroviral therapy program involving weekly home visits in Uganda were assessed through interviews at enrollment and after 3 months and analyzed using generalized estimating equations.

Results: Of 654 participants, 72% were women; median baseline CD4 cell-count was 123 cells/μL. At follow-up, participants were more likely to report community support (adjusted odds ratio [OR] 2.10, 95% confidence interval [CI]: 1.46 to 3.03, P < 0.001), family support (OR 2.65, CI: 2.01 to 3.49, P < 0.001), and relationship strengthening (OR 2.10, CI: 1.46 to 3.03, P = 0.001) than at baseline; 84% attributed these experiences to antiretroviral therapy program participation. There was no change in incidence of negative experiences (P = 0.3). Forty-six percent of women reported a history of partner abuse, but abuse rates 3 months before and after program initiation were low (1% vs. 2%, OR 3.20, CI: 0.94 to 10.9, P = 0.063). Of five women who reported abuse associated with program participation, all had history of domestic violence. Of all participants reporting outcomes associated with antiretroviral therapy program participation at follow-up, 464 (79%) had only positive experiences, 35 (6%) had both positive and negative experiences, and <1% had only negative experiences.

Conclusions: Participation in a home-based antiretroviral therapy program was associated with multiple positive social outcomes.

From *CDC-Uganda, Global AIDS Program, Entebbe, Uganda; †The University of California, San Francisco, CA; ‡Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA; and §The AIDS Support Organization, Kampala, Uganda.

Received for publication December 16, 2005; accepted August 18, 2006.

Reprints: Rose Apondi, BA, Uganda Virus Research Institute, PO Box 49, Entebbe, Uganda (e-mail: apondi@UG.CDC.GOV).

© 2007 Lippincott Williams & Wilkins, Inc.