Noninferiority of a Task-Shifting HIV Care an Treatment Model Using Peer Counselors and Nurses Among Ugandan Women Initiated on ART: Evidence From a Randomized Trial
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Date
2013
Authors
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Journal ISSN
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Publisher
Lippincott Williams & Wilkins
Abstract
Objective: To assess the noninferiority of a task-shifting HIV
treatment model relying on peer counselors and nurses compared
with a physician-centered model among HIV-1-positive women
initiated on antiretroviral therapy (ART) at a prevention of motherto-child transmission clinic in Mulago Hospital, Uganda.
Methods: HIV-1-infected ART eligible naive women were randomized to either nurse–peer (intervention) or doctor–counselor (standard
model) arm. The primary endpoint was virologic success defined
attaining a viral load , 400 RNA copies per milliliter 6–12 months
after ART initiation. Noninferiority was defined as the lower 95%
confidence limit for the difference in proportions with virologic success being less than 10%. Secondary outcomes included immunologic
success (mean CD4 count increase from baseline) and pill count.
Results: Data on 85 participants were analyzed (n = 45 in the
intervention and n = 40 in the standard model). The proportion of
participants with virologic success was similar in the standard and
intervention models [91% versus 88% respectively; difference, 3%;
95% confidence interval (CI): 211% to 12%]. Probability of viral
detection at 6–12 months’ time point was similar in the 2 models(log-rank test P = 0.73). Immunologic and pill count indicators were
also similar in the intervention and standard models, with mean CD4
increase of 217 versus 206 cells per microliter (difference, 11; 95%
CI: 260 to 82 cells/mL) and pill counts of 99.8% versus 99.7%
(difference, 0.0; 95% CI: 25% to 5%) respectively.
Conclusions: Nurses and peer counselors were not inferior in
providing ART follow-up care to postpartum women, an approach
that may help deliver treatment to many more HIV-infected people.
Description
Keywords
HIV, Adherence, Task-shifting, Antiretroviral therapy, Nurses, Peers, Intervention
Citation
Kiweewa, F. M., Wabwire, D., Nakibuuka, J., Mubiru, M., Bagenda, D., Musoke, P., ... & Antelman, G. (2013). Noninferiority of a task-shifting HIV care and treatment model using peer counselors and nurses among Ugandan women initiated on ART: evidence from a randomized trial. JAIDS Journal of Acquired Immune Deficiency Syndromes, 63(4), e125-e132.