Effect of peer health workers on AIDS care in Rakai, Uganda: a cluster-randomized trial.
Effect of peer health workers on AIDS care in Rakai, Uganda: a cluster-randomized trial.
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DOI：
10.1371/journal.pone.0010923
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发表时间：
2010-06-02
期刊：
影响因子：
3.7
通讯作者：
Reynolds SJ
中科院分区：
文献类型：
--
作者：
Chang LW;Kagaayi J;Nakigozi G;Ssempijja V;Packer AH;Serwadda D;Quinn TC;Gray RH;Bollinger RC;Reynolds SJ
人力资源的限制是在低资源环境中提供抗逆转录病毒治疗（ART）的挑战。为评估社区同伴卫生工作者（PHW）对乌干达Rakai地区成人艾滋病护理的影响，采用2∶1随机分组法，将15家艾滋病诊所分为社区同伴卫生工作者干预组（n = 10）和对照组（n = 5）。PHW的任务包括诊所和家庭提供咨询、临床、坚持抗逆转录病毒治疗和社会支持。主要结局是依从性和累积病毒学失败风险（bb0 - 400拷贝/mL）。次要结果是每个24周时间点的病毒学失败，直至抗逆转录病毒治疗192周。分析的目的是治疗。2006年5月至2008年7月随访1336例。这些患者中有444人（33%）在研究开始时已经在接受抗逆转录病毒治疗。缺乏依从性（<95%片剂计数依从性风险比[RR] 0.55, 95%可信区间[CI] 0.23-1.35; <100%依从性RR 1.10, 95% CI 0.94-1.30）、病毒学失败累积风险（RR 0.81, 95% CI 0.61-1.08）或短期病毒学结局（24周病毒学失败RR 0.93, 95% CI 0.65-1.32； 48周，RR 0.83, 95% CI 0.47-1.48； 72周，RR 0.81, 95% CI 0.44-1.49）均无显著差异。然而，与对照组相比，干预组ART治疗≥96周的病毒学失败率显著降低（96周失败RR 0.50, 95% CI 0.31-0.81； 120周，RR 0.59, 95% CI 0.22-1.60； 144周，RR 0.39, 95% CI 0.16-0.95； 168周，RR 0.30, 95% CI 0.097-0.92； 192周，RR 0.067, 95% CI 0.0065-0.71）。PHW干预与进入ART治疗96周及更长时间的病毒学失败率降低有关，但不影响病毒学失败的累积风险、依从性措施或短期病毒学结果。在资源匮乏的环境中，初级保健可能是维持长期抗逆转录病毒治疗的有效干预措施。ClinicalTrials.gov NCT00675389
Human resource limitations are a challenge to the delivery of antiretroviral therapy (ART) in low-resource settings. We conducted a cluster randomized trial to assess the effect of community-based peer health workers (PHW) on AIDS care of adults in Rakai, Uganda. 15 AIDS clinics were randomized 2∶1 to receive the PHW intervention (n = 10) or control (n = 5). PHW tasks included clinic and home-based provision of counseling, clinical, adherence to ART, and social support. Primary outcomes were adherence and cumulative risk of virologic failure (>400 copies/mL). Secondary outcomes were virologic failure at each 24 week time point up to 192 weeks of ART. Analysis was by intention to treat. From May 2006 to July 2008, 1336 patients were followed. 444 (33%) of these patients were already on ART at the start of the study. No significant differences were found in lack of adherence (<95% pill count adherence risk ratio [RR] 0.55, 95% confidence interval [CI] 0.23–1.35; <100% adherence RR 1.10, 95% CI 0.94–1.30), cumulative risk of virologic failure (RR 0.81, 95% CI 0.61–1.08) or in shorter-term virologic outcomes (24 week virologic failure RR 0.93, 95% CI 0.65–1.32; 48 week, RR 0.83, 95% CI 0.47–1.48; 72 week, RR 0.81, 95% CI 0.44–1.49). However, virologic failure rates ≥96 weeks into ART were significantly decreased in the intervention arm compared to the control arm (96 week failure RR 0.50, 95% CI 0.31–0.81; 120 week, RR 0.59, 95% CI 0.22–1.60; 144 week, RR 0.39, 95% CI 0.16–0.95; 168 week, RR 0.30, 95% CI 0.097–0.92; 192 week, RR 0.067, 95% CI 0.0065–0.71). A PHW intervention was associated with decreased virologic failure rates occurring 96 weeks and longer into ART, but did not affect cumulative risk of virologic failure, adherence measures, or shorter-term virologic outcomes. PHWs may be an effective intervention to sustain long-term ART in low-resource settings. ClinicalTrials.gov NCT00675389
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DOI：
10.1097/qai.0b013e3181988375
发表时间：
2009-03-01
期刊：
Journal of acquired immune deficiency syndromes (1999)
影响因子：
--
作者：
Chang LW;Alamo S;Guma S;Christopher J;Suntoke T;Omasete R;Montis JP;Quinn TC;Juncker M;Reynolds SJ
通讯作者：
Reynolds SJ
影响因子：
56.3
作者：
Zachariah, Rony;Harries, Anthony D.;Reid, Tony
通讯作者：
Reid, Tony
影响因子：
4.9
作者：
Barnighausen, Till;Bloom, David E.;Humair, Salal
通讯作者：
Humair, Salal
影响因子：
168.9
作者：
Gray, Ronald H.;Kigozi, Godfrey;Wawer, Maria J.
通讯作者：
Wawer, Maria J.
DOI：
10.1136/bmj.a2390
发表时间：
2008-11-11
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Zwarenstein M;Treweek S;Gagnier JJ;Altman DG;Tunis S;Haynes B;Oxman AD;Moher D;CONSORT group;Pragmatic Trials in Healthcare (Practihc) group
通讯作者：
Pragmatic Trials in Healthcare (Practihc) group