Effect of Community Support Agents on Retention of People Living With HIV in Pre-antiretroviral Care: A Randomized Controlled Trial in Eastern Uganda
Background: Over 50% of people living with HIV (PLHIV) in sub-Saharan Africa are lost to follow-up between diagnosis and initiation of antiretroviral treatment during pre-antiretroviral (pre-ARV) care. The effect of providing home counseling visits by community support agents on 2-year retention in pre-ARV care was evaluated through a randomized controlled trial in eastern Uganda.
Methods: Four hundred newly screened HIV-positive patients were randomly assigned to receive post-test counseling alone (routine arm) or posttest counseling and monthly home counseling visits by community support agents to encourage them go back for routine pre-ARV care (intervention arm). The outcome measure was the proportion of new PLHIV in either arm who attended their scheduled pre-ARV care visits for at least 6 of the anticipated 8 visits in the first 24 months after HIV diagnosis. The difference between the 2 study arms was assessed using the χ2 and T tests. Mantel–Haenszel Risk Ratios and multivariate logistic models were used to assess the adjusted effect of the intervention on the outcome.
Results: In all models generated, participants receiving monthly home counseling visits were 2.5 times more likely to be retained in pre-ARV compared with those in standard care over a period of 24 months (adjusted risk ratio, 2.5; 95% confidence interval: 2.0 to 3.0).
Conclusion: Monthly follow-up home visits by community workers more than doubled the retention of PLHIV in pre-ARV care in rural Uganda and can be applicable in similar resource-poor settings.