Open Access Research article

Effect of home-based interventions on virologic outcomes in adults receiving antiretroviral therapy in Africa: a meta-analysis

Nathaniel Chishinga12*, Peter Godfrey-Faussett2, Katherine Fielding3 and Helen Ayles12

Author Affiliations

1 Zambia AIDS-related TB Project, School of Medicine, P.O Box 50697, Ridgeway campus, Lusaka, Zambia

2 Department of Clinical Research, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK

3 Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK

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BMC Public Health 2014, 14:239  doi:10.1186/1471-2458-14-239

Published: 7 March 2014

Abstract

Background

The success of adherence to combination antiretroviral therapy (ART) in sub-Saharan Africa is hampered by factors that are unique to this setting. Home based interventions have been identified as possible strategies for decentralizing ART care and improving access and adherence to ART. There is need for evidence at individual- or community-level of the benefits of home-based interventions in improving HIV suppression in African patients receiving ART.

Methods

We conducted a systematic review and meta-analysis of the literature to assess the effect of home-based interventions on virologic outcomes in adults receiving ART in Africa.

Results

A total of 260 publications were identified by the search strategy, 249 were excluded on initial screening and 11 on full review, leaving 5 publications for analysis. The overall OR of virologic suppression at 12 months after starting ART of home-based interventions to standard of care was 1.13 (95% CI: 0.51–2.52).

Conclusions

There was insufficient data to know whether there is a difference in HIV suppression at 12 months in the home-based arm compared with the standard of care arm in adults receiving ART in Africa. Given the few trials conducted from Africa, there is need for further research that measures the effects of home-based models on HIV suppression in African populations.

Keywords:
HIV; Virologic outcomes; Home-based interventions; Antiretroviral therapy; Meta-analysis; Sub-Saharan Africa