Community-Based Accompaniment with Supervised Antiretrovirals for HIV-Positive Adults in Peru: A Cluster-Randomized Trial
We conducted a cluster-randomized trial to estimate effects of directly observed combination antiretroviral therapy (DOT-cART) on retention with viral suppression among HIV-positive adults in Peru. We randomly allocated facilities to receive the 12-month intervention plus the standard of care, inclu...
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2017
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| author | Megan McLaughlin Molly F. Franke Maribel Muñoz Adrianne Katrina Nelson Olga Saldaña Janeth Santa Cruz Milagros Wong Zibiao Zhang Leonid Lecca Eduardo Ticona Jorge Arévalo Eduardo Sánchez J.L. Sebastián Sonya Shin |
| author_browse | Adrianne Katrina Nelson Eduardo Sánchez Eduardo Ticona J.L. Sebastián Janeth Santa Cruz Jorge Arévalo Leonid Lecca Maribel Muñoz Megan McLaughlin Milagros Wong Molly F. Franke Olga Saldaña Sonya Shin Zibiao Zhang |
| author_facet | Megan McLaughlin Molly F. Franke Maribel Muñoz Adrianne Katrina Nelson Olga Saldaña Janeth Santa Cruz Milagros Wong Zibiao Zhang Leonid Lecca Eduardo Ticona Jorge Arévalo Eduardo Sánchez J.L. Sebastián Sonya Shin |
| author_sort | Megan McLaughlin |
| collection | Producción científica |
| description | We conducted a cluster-randomized trial to estimate effects of directly observed combination antiretroviral therapy (DOT-cART) on retention with viral suppression among HIV-positive adults in Peru. We randomly allocated facilities to receive the 12-month intervention plus the standard of care, including adherence support provided through accompaniment. In the intervention arm, health workers supervised doses, twice daily, and accompanied patients to appointments. Among 356 patients, intention-to-treat analyses showed no statistically significant benefit of DOT, relative to no-DOT, at 12 or 24 months (adjusted probability of primary outcome: 0.81 vs. 0.73 and 0.76 vs. 0.68, respectively). A statistically significant benefit of DOT was found in per-protocol and as-treated analyses at 12 months (0.83 for DOT vs. 0.73 for no DOT, p value: 0.02 per-protocol, 0.01 as-treated), but not 24 months. Rates of retention with viral suppression were high in both arms. Among adults receiving robust adherence support, the added effect of time-limited DOT, if any, is small-to-moderate. |
| format | Article |
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| fuente_tipo_str_mv | CRIS|Article |
| id | oai:cris.upeu.edu.pe:20.500.15037/930 |
| institution | UPeU |
| language | English |
| publishDate | 2017 |
| publishDateRange | 2017 |
| publishDateSort | 2017 |
| record_format | dspace |
| spelling | oai:cris.upeu.edu.pe:20.500.15037/9302026-11-02T22:34:06ZCommunity-Based Accompaniment with Supervised Antiretrovirals for HIV-Positive Adults in Peru: A Cluster-Randomized TrialMegan McLaughlinMolly F. FrankeMaribel MuñozAdrianne Katrina NelsonOlga SaldañaJaneth Santa CruzMilagros WongZibiao ZhangLeonid LeccaEduardo TiconaJorge ArévaloEduardo SánchezJ.L. SebastiánSonya ShinMedicineCartHuman immunodeficiency virus (HIV)Randomized controlled trialPublic healthHealth psychologyCluster (spacecraft)Cluster randomised controlled trialInternal medicineAntiretroviral therapyIntervention (counseling)Viral loadPhysical therapyImmunologyPsychiatryComputer scienceNursingMechanical engineeringProgramming languageEngineeringMedicineCartHuman immunodeficiency virus (HIV)Randomized controlled trialPublic healthHealth psychologyCluster (spacecraft)Cluster randomised controlled trialInternal medicineAntiretroviral therapyIntervention (counseling)Viral loadPhysical therapyImmunologyPsychiatryRetention in CareRetention in CareRetention in CareAdultAdultAdultAppointments and SchedulesAppointments and SchedulesAppointments and SchedulesCommunity Health ServicesCommunity Health ServicesCommunity Health ServicesFemaleFemaleFemaleHumansHumansHumansMaleMaleMaleMiddle AgedMiddle AgedMiddle AgedPeruPeruPeruSocial SupportSocial SupportSocial SupportHIV Infections drug therapyHIV Infections drug therapyHIV Infections drug therapyHIV Infections psychologyHIV Infections psychologyHIV Infections psychologyHIV Infections virologyHIV Infections virologyHIV Infections virologyTreatment OutcomeTreatment OutcomeTreatment OutcomeDelivery of Health Care, Integrated organization & administrationDelivery of Health Care, Integrated organization & administrationDelivery of Health Care, Integrated organization & administrationViral Load drug effectsViral Load drug effectsViral Load drug effectsAntiretroviral Therapy, Highly Active methodsAntiretroviral Therapy, Highly Active methodsAntiretroviral Therapy, Highly Active methodsAntiretroviral Therapy, Highly Active psychologyAntiretroviral Therapy, Highly Active psychologyAntiretroviral Therapy, Highly Active psychologyDirectly Observed TherapyDirectly Observed TherapyDirectly Observed TherapyHealth Sciences Medicine Infectious Diseases HIV/AIDS Research and InterventionsHealth Sciences Medicine Epidemiology HIV, Drug Use, Sexual RiskLife Sciences Immunology and Microbiology Virology HIV Research and TreatmentWe conducted a cluster-randomized trial to estimate effects of directly observed combination antiretroviral therapy (DOT-cART) on retention with viral suppression among HIV-positive adults in Peru. We randomly allocated facilities to receive the 12-month intervention plus the standard of care, including adherence support provided through accompaniment. In the intervention arm, health workers supervised doses, twice daily, and accompanied patients to appointments. Among 356 patients, intention-to-treat analyses showed no statistically significant benefit of DOT, relative to no-DOT, at 12 or 24 months (adjusted probability of primary outcome: 0.81 vs. 0.73 and 0.76 vs. 0.68, respectively). A statistically significant benefit of DOT was found in per-protocol and as-treated analyses at 12 months (0.83 for DOT vs. 0.73 for no DOT, p value: 0.02 per-protocol, 0.01 as-treated), but not 24 months. Rates of retention with viral suppression were high in both arms. Among adults receiving robust adherence support, the added effect of time-limited DOT, if any, is small-to-moderate.Articlehttps://pubmed.ncbi.nlm.nih.gov/2807442110.1007/s10461-017-1680-2https://hdl.handle.net/20.500.15037/930W2568800069enAIDS and Behavior1090-71651573-32542017-01-102026-06-13T09:40:47Z2026-06-13T09:40:47Z |
| spellingShingle | Medicine Cart Human immunodeficiency virus (HIV) Randomized controlled trial Public health Health psychology Cluster (spacecraft) Cluster randomised controlled trial Internal medicine Antiretroviral therapy Intervention (counseling) Viral load Physical therapy Immunology Psychiatry Computer science Nursing Mechanical engineering Programming language Engineering Medicine Cart Human immunodeficiency virus (HIV) Randomized controlled trial Public health Health psychology Cluster (spacecraft) Cluster randomised controlled trial Internal medicine Antiretroviral therapy Intervention (counseling) Viral load Physical therapy Immunology Psychiatry Retention in Care Retention in Care Retention in Care Adult Adult Adult Appointments and Schedules Appointments and Schedules Appointments and Schedules Community Health Services Community Health Services Community Health Services Female Female Female Humans Humans Humans Male Male Male Middle Aged Middle Aged Middle Aged Peru Peru Peru Social Support Social Support Social Support HIV Infections drug therapy HIV Infections drug therapy HIV Infections drug therapy HIV Infections psychology HIV Infections psychology HIV Infections psychology HIV Infections virology HIV Infections virology HIV Infections virology Treatment Outcome Treatment Outcome Treatment Outcome Delivery of Health Care, Integrated organization & administration Delivery of Health Care, Integrated organization & administration Delivery of Health Care, Integrated organization & administration Viral Load drug effects Viral Load drug effects Viral Load drug effects Antiretroviral Therapy, Highly Active methods Antiretroviral Therapy, Highly Active methods Antiretroviral Therapy, Highly Active methods Antiretroviral Therapy, Highly Active psychology Antiretroviral Therapy, Highly Active psychology Antiretroviral Therapy, Highly Active psychology Directly Observed Therapy Directly Observed Therapy Directly Observed Therapy Health Sciences Medicine Infectious Diseases HIV/AIDS Research and Interventions Health Sciences Medicine Epidemiology HIV, Drug Use, Sexual Risk Life Sciences Immunology and Microbiology Virology HIV Research and Treatment Megan McLaughlin Molly F. Franke Maribel Muñoz Adrianne Katrina Nelson Olga Saldaña Janeth Santa Cruz Milagros Wong Zibiao Zhang Leonid Lecca Eduardo Ticona Jorge Arévalo Eduardo Sánchez J.L. Sebastián Sonya Shin Community-Based Accompaniment with Supervised Antiretrovirals for HIV-Positive Adults in Peru: A Cluster-Randomized Trial |
| title | Community-Based Accompaniment with Supervised Antiretrovirals for HIV-Positive Adults in Peru: A Cluster-Randomized Trial |
| title_full | Community-Based Accompaniment with Supervised Antiretrovirals for HIV-Positive Adults in Peru: A Cluster-Randomized Trial |
| title_fullStr | Community-Based Accompaniment with Supervised Antiretrovirals for HIV-Positive Adults in Peru: A Cluster-Randomized Trial |
| title_full_unstemmed | Community-Based Accompaniment with Supervised Antiretrovirals for HIV-Positive Adults in Peru: A Cluster-Randomized Trial |
| title_short | Community-Based Accompaniment with Supervised Antiretrovirals for HIV-Positive Adults in Peru: A Cluster-Randomized Trial |
| title_sort | community based accompaniment with supervised antiretrovirals for hiv positive adults in peru a cluster randomized trial |
| topic | Medicine Cart Human immunodeficiency virus (HIV) Randomized controlled trial Public health Health psychology Cluster (spacecraft) Cluster randomised controlled trial Internal medicine Antiretroviral therapy Intervention (counseling) Viral load Physical therapy Immunology Psychiatry Computer science Nursing Mechanical engineering Programming language Engineering Medicine Cart Human immunodeficiency virus (HIV) Randomized controlled trial Public health Health psychology Cluster (spacecraft) Cluster randomised controlled trial Internal medicine Antiretroviral therapy Intervention (counseling) Viral load Physical therapy Immunology Psychiatry Retention in Care Retention in Care Retention in Care Adult Adult Adult Appointments and Schedules Appointments and Schedules Appointments and Schedules Community Health Services Community Health Services Community Health Services Female Female Female Humans Humans Humans Male Male Male Middle Aged Middle Aged Middle Aged Peru Peru Peru Social Support Social Support Social Support HIV Infections drug therapy HIV Infections drug therapy HIV Infections drug therapy HIV Infections psychology HIV Infections psychology HIV Infections psychology HIV Infections virology HIV Infections virology HIV Infections virology Treatment Outcome Treatment Outcome Treatment Outcome Delivery of Health Care, Integrated organization & administration Delivery of Health Care, Integrated organization & administration Delivery of Health Care, Integrated organization & administration Viral Load drug effects Viral Load drug effects Viral Load drug effects Antiretroviral Therapy, Highly Active methods Antiretroviral Therapy, Highly Active methods Antiretroviral Therapy, Highly Active methods Antiretroviral Therapy, Highly Active psychology Antiretroviral Therapy, Highly Active psychology Antiretroviral Therapy, Highly Active psychology Directly Observed Therapy Directly Observed Therapy Directly Observed Therapy Health Sciences Medicine Infectious Diseases HIV/AIDS Research and Interventions Health Sciences Medicine Epidemiology HIV, Drug Use, Sexual Risk Life Sciences Immunology and Microbiology Virology HIV Research and Treatment |
| topic_facet | Medicine Cart Human immunodeficiency virus (HIV) Randomized controlled trial Public health Health psychology Cluster (spacecraft) Cluster randomised controlled trial Internal medicine Antiretroviral therapy Intervention (counseling) Viral load Physical therapy Immunology Psychiatry Computer science Nursing Mechanical engineering Programming language Engineering Medicine Cart Human immunodeficiency virus (HIV) Randomized controlled trial Public health Health psychology Cluster (spacecraft) Cluster randomised controlled trial Internal medicine Antiretroviral therapy Intervention (counseling) Viral load Physical therapy Immunology Psychiatry Retention in Care Retention in Care Retention in Care Adult Adult Adult Appointments and Schedules Appointments and Schedules Appointments and Schedules Community Health Services Community Health Services Community Health Services Female Female Female Humans Humans Humans Male Male Male Middle Aged Middle Aged Middle Aged Peru Peru Peru Social Support Social Support Social Support HIV Infections drug therapy HIV Infections drug therapy HIV Infections drug therapy HIV Infections psychology HIV Infections psychology HIV Infections psychology HIV Infections virology HIV Infections virology HIV Infections virology Treatment Outcome Treatment Outcome Treatment Outcome Delivery of Health Care, Integrated organization & administration Delivery of Health Care, Integrated organization & administration Delivery of Health Care, Integrated organization & administration Viral Load drug effects Viral Load drug effects Viral Load drug effects Antiretroviral Therapy, Highly Active methods Antiretroviral Therapy, Highly Active methods Antiretroviral Therapy, Highly Active methods Antiretroviral Therapy, Highly Active psychology Antiretroviral Therapy, Highly Active psychology Antiretroviral Therapy, Highly Active psychology Directly Observed Therapy Directly Observed Therapy Directly Observed Therapy Health Sciences Medicine Infectious Diseases HIV/AIDS Research and Interventions Health Sciences Medicine Epidemiology HIV, Drug Use, Sexual Risk Life Sciences Immunology and Microbiology Virology HIV Research and Treatment |
| url | https://pubmed.ncbi.nlm.nih.gov/28074421 https://hdl.handle.net/20.500.15037/930 |
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