Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
J Acquir Immune Defic Syndr. 2010 Dec;55(4):483-90. doi: 10.1097/QAI.0b013e3181eb5edb.
To assess whether community-based care delivered by people living with HIV/AIDS (PLWAs) could replace clinic-based HIV care.
Prospective cluster randomized controlled clinical trial.
Villages surrounding 1 rural clinic in western Kenya.
HIV-infected adults clinically stable on antiretroviral therapy (ART).
The intervention group received monthly Personal Digital Assistant supported home assessments by PLWAs with clinic appointments every 3 months. The control group received standard of care monthly clinic visits.
Viral load, CD4 count, Karnofsky score, stability of ART regimen, opportunistic infections, pregnancies, and number of clinic visits.
After 1 year, there were no significant intervention-control differences with regard to detectable viral load, mean CD4 count, decline in Karnofsky score, change in ART regimen, new opportunistic infection, or pregnancy rate. Intervention patients made half as many clinic visits as did controls (P < 0.001).
Community-based care by PLWAs resulted in similar clinical outcomes as usual care but with half the number of clinic visits. This pilot study suggests that task-shifting and mobile technologies can deliver safe and effective community-based care to PLWAs, expediting ART rollout and increasing access to treatment while expanding the capacity of health care institutions in resource-constrained environments.
评估由艾滋病毒/艾滋病感染者（PLWAs）提供的基于社区的护理是否可以替代诊所为基础的艾滋病毒护理。
前瞻性集群随机对照临床试验。
肯尼亚西部一个农村诊所周围的村庄。
接受抗逆转录病毒疗法（ART）治疗且临床稳定的艾滋病毒感染者成年人。
干预组每月接受一次由 PLWAs 通过个人数字助理进行的家庭评估，每 3 个月进行一次诊所预约。对照组接受每月一次的常规诊所就诊。
病毒载量、CD4 计数、卡诺夫斯基评分、ART 方案的稳定性、机会性感染、妊娠和诊所就诊次数。
一年后，在可检测病毒载量、平均 CD4 计数、卡诺夫斯基评分下降、ART 方案改变、新发机会性感染或妊娠率方面，干预组与对照组之间没有显著差异。干预组患者的就诊次数比对照组少一半（P<0.001）。
PLWAs 提供的基于社区的护理在临床结果上与常规护理相似，但就诊次数减少了一半。这项试点研究表明，任务转移和移动技术可以为 PLWAs 提供安全有效的基于社区的护理，加快 ART 的推广，增加治疗的可及性，同时扩大资源有限环境中医疗机构的能力。
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