New research from the University of Alberta's School of Public Health has demonstrated that community-based resources in rural Uganda can successfully provide HIV treatments to patients, where economic and geographical barriers would typically prevent access to care.
Working with the Kabarole District Health Department and colleagues at Makerere University in Kampala, Uganda, the researchers implemented a new model by which volunteers were trained to provide basic care to HIV patients in Rwimi sub-county.
When comparing the viral loads of 185 patients within the community-based model to 200 patients of a well-established hospital-based program, they found that the viral loads were equivalent or better than those in the hospital-based program.
"After two years, 93 per cent of patients in the community-based model and 87 per cent of patients in the hospital-based model showed viral suppression," says Walter Kipp, professor in the School. "This model supports the idea that community-based, primary health care can be successful."
Traveling by bicycle, 40 volunteers paid weekly visits to an average of five patients each to deliver antiretroviral drugs, monitor and support adherence to treatment and assess their condition. As part of the visit, they recorded their findings and referred any patients with adverse reactions or other clinical problems to the nearby health centre.
According to Joseph Konde-Lule, professor of epidemiology at Makerere University, the study provides much-needed evidence to support new strategies within the Ministry of Health. "Shifting some of the responsibilities of health care from highly trained to less-trained individuals is supported by the World Health Organization and is now one of the driving policies for the Uganda Ministry of Health," he says. "This study provides the scientific proof regarding the effectiveness of volunteers and should facilitate implementing this policy in Uganda."
Kipp also hopes that the program will be implemented in other areas of Uganda to address the barriers to treatment for HIV patients. "You can clearly see that hospital-based treatments are not the only answer in this region because many rural residents just can't access them," he says. "This program provided care to many people who would not have survived without it."
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The results of the study were published online at the Plos One. The journal article is available at www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0040902