Community support improves HIV treatment outcomes for patients in South Africa

Community-support initiatives significantly improve responses to antiretroviral therapy amongst patients in South Africa, a study published in the November 30^th edition of AIDS shows. In addition, the research showed that baseline characteristics were also important for the first six months, and the investigators suggest that community support is particularly valuable at this time for patients who start HIV treatment with a low CD4 cell count and high viral load.

Lack of trained healthcare staff is often given as a reason for not expanding access to antiretroviral treatment in resource-limited settings, including the Free State Province of South Africa.

Community-support services can fill the gaps left by formal healthcare structures. The potential impact of such services is, however, poorly understood.

Researchers therefore looked at the six- and twelve-month immunologic and virological outcomes of 268 patients starting antiretroviral treatment. They investigated the effect of demographic characteristics, baseline CD4 cell count and viral load, and three different types of community support (treatment buddy, community health workers, support group) on these patients.

All the patients started HIV treatment when their CD4 cell count was below 200 cells/mm³ (median 109 cells/mm³). Mean age was 38 years. Treatment was deemed to be an immunologic success if the CD4 cell count increased to above 200 cells/mm³ and viral load fell below 400 copies/ml.

After six months of antiretroviral therapy, median CD4 cell count had increased to 236 cells/mm³ and 55% of individuals had a count above 200 cells/mm³. At this time point, 85% of patients had a viral load below 400 copies/ml.

Characteristics associated with successful outcomes after six months of therapy were baseline CD4 cell count (p

Support from a treatment buddy (p

After twelve months of HIV treatment, successful treatment responses had ceased to be significantly associated with patients’ baseline characteristics.

However, patients who received all three types of community support were significantly more likely to have good treatment outcomes compared to patients who did not receive such support (all comparisons, p

“HIV/AIDS patients commencing antiretroviral therapy with support from treatment buddies, community health workers and or/support groups had more favourable virological and immunological responses than those without such support”, comment the investigators.

Given that baseline characteristics had a significant effect on treatment outcomes at six months, the investigators suggest that “community-support initiatives should initially target patients with very low CD4 cell counts and high baseline viral load, because delayed antiretroviral initiation was associated with significantly reduced treatment responses.”

They conclude, “These findings stress the importance of community support in achieving durable treatment success and indicate that health policy makers should acknowledge and strengthen community response in the fight against HIV/AIDS.”