The effectiveness and cost-effectiveness of community-based support for adolescents receiving antiretroviral treatment : an operational research study in South Africa

Show simple item record Fatti, Geoffrey Jackson, Debra Goga, Ameena Ebrahim Shaikh, Najma Eley, Brian Nachega, Jean B. Grimwood, Ashraf 2018-09-12T05:39:13Z 2018-09-12T05:39:13Z 2018-02-28
dc.description.abstract INTRODUCTION : Adolescents and youth receiving antiretroviral treatment (ART) in sub-Saharan Africa have high attrition and inadequate ART outcomes, and evaluations of interventions improving ART outcomes amongst adolescents are very limited. Sustainable Development Goal (SDG) target 3c is to substantially increase the health workforce in developing countries. We measured the effectiveness and cost-effectiveness of community-based support (CBS) provided by lay health workers for adolescents and youth receiving ART in South Africa. METHODS : A retrospective cohort study including adolescents and youth who initiated ART at 47 facilities. Previously unemployed CBS-workers provided home-based ART-related education, psychosocial support, symptom screening for opportunistic infections and support to access government grants. Outcomes were compared between participants who received CBS plus standard clinic-based care versus participants who received standard care only. Cumulative incidences of all-cause mortality and loss to follow-up (LTFU), adherence measured using medication possession ratios (MPRs), CD4 count slope, and virological suppression were analysed using multivariable Cox, competing-risks regression, generalized estimating equations and mixedeffects models over five years of ART. An expenditure approach was used to determine the incremental cost of CBS to usual care from a provider perspective. Incremental cost-effectiveness ratios were calculated as annual cost per patient-loss (through death or LTFU) averted. RESULTS : Amongst 6706 participants included, 2100 (31.3%) received CBS. Participants who received CBS had reduced mortality, adjusted hazard ratio (aHR) = 0.52 (95% CI: 0.37 to 0.73; p < 0.0001). Cumulative LTFU was 40% lower amongst participants receiving CBS (29.9%) compared to participants without CBS (38.9%), aHR = 0.60 (95% CI: 0.51 to 0.71); p < 0.0001). The effectiveness of CBS in reducing attrition ranged from 42.2% after one year to 35.9% after five years. Virological suppression was similar after three years, but after five years 18.8% CBS participants versus 37.2% non-CBS participants failed to achieve viral suppression, adjusted odds ratio = 0.24 (95% CI: 0.06 to 1.03). There were no significant differences in MPR or CD4 slope. The cost of CBS was US$49.5/patient/year. The incremental cost per patient-loss averted was US$600 and US$776 after one and two years, respectively. CONCLUSIONS : CBS for adolescents and youth receiving ART was associated with substantially reduced patient attrition, and is a low-cost intervention with reasonable cost-effectiveness that can aid progress towards several health, economic and equality- related SDG targets. en_ZA
dc.description.department Paediatrics and Child Health en_ZA
dc.description.librarian am2018 en_ZA
dc.description.sponsorship The authors gratefully acknowledge the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the Departments of Health of KwaZulu-Natal, Eastern Cape, Western Cape and Mpumalanga. Funding for the study was provided by the US President’s Emergency Plan for AIDS Relief, USAID. This research has been supported by the U.S. Presidents' Emergency Plan for AIDS Relief (PEPFAR, grant number U51HA02522) through Centers for Disease Control and Prevention under the terms of grant 5U2GPS001966. en_ZA
dc.description.uri en_ZA
dc.identifier.citation Fatti, G., Jackson, D., Goga, A.E. et al. 2018, 'The effectiveness and cost-effectiveness of community-based support for adolescents receiving antiretroviral treatment : an operational research study in South Africa', Journal of the International AIDS Society, vol. 21, art. no. e25041, pp. 1-12. en_ZA
dc.identifier.issn 1758-2652 (online)
dc.identifier.other 10.1002/jia2.25041
dc.language.iso en en_ZA
dc.publisher Wiley Open Access en_ZA
dc.rights © 2018 The Authors. Journal of the International AIDS Society published by John Wiley & sons Ltd on behalf of the International AIDS Society. This is an open access article under the terms of the Creative Commons Attribution License. en_ZA
dc.subject Antiretroviral treatment (ART) en_ZA
dc.subject Adolescents en_ZA
dc.subject United Nations sustainable development goals en_ZA
dc.subject Community-based support en_ZA
dc.subject Cost-effectiveness en_ZA
dc.subject Human immunodeficiency virus (HIV) en_ZA
dc.subject Adult patients en_ZA
dc.subject Follow-up en_ZA
dc.subject Health workers en_ZA
dc.subject HIV care en_ZA
dc.subject Therapy adherence en_ZA
dc.subject Treatment programs en_ZA
dc.subject Sub-Saharan Africa (SSA) en_ZA
dc.subject Middle-income countries en_ZA
dc.subject Sustainable development goals (SDGs) en_ZA
dc.title The effectiveness and cost-effectiveness of community-based support for adolescents receiving antiretroviral treatment : an operational research study in South Africa en_ZA
dc.type Article en_ZA

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