School of Public Health, University of Alberta, 3-50 University Terrace, 8303-112 Street, Edmonton, AB, Canada, T6G 2T4.
BMC Int Health Hum Rights. 2011 Nov 8;11 Suppl 2(Suppl 2):S12. doi: 10.1186/1472-698X-11-S2-S12.
Improved availability of antiretroviral therapy in sub-Saharan Africa is intended to benefit all eligible HIV-infected patients; however in reality antiretroviral services are mainly offered in urban hospitals. Poor rural patients have difficulty accessing the drugs, making the provision of antiretroviral therapy inequitable. Initial tests of community-based treatment programs in Uganda suggest that home-based treatment of HIV/AIDS may equal hospital-based treatment; however the literature reveals limited experiences with such programs.
This intervention study aimed to; 1) assess the effectiveness of a rural community-based ART program in a subcounty (Rwimi) of Uganda; and 2) compare treatment outcomes and mortality in a rural community-based antiretroviral therapy program with a well-established hospital-based program. Ethics approvals were obtained in Canada and Uganda.
Successful treatment outcomes after two years in both the community and hospital cohorts were high. All-cause mortality was similar in both cohorts. However, community-based patients were more likely to achieve viral suppression and had good adherence to treatment. The community-based program was slightly more cost-effective. Per capita costs in both settings were unsustainable, representing more than Uganda's Primary Health Care Services current expenditures per person per year for all health services. The unpaid community volunteers showed high participation and low attrition rates for the two years that this program was evaluated.
Key successes of this study include the demonstration that antiretroviral therapy can be provided in a rural setting, the creation of a research infrastructure and culture within Kabarole's health system, and the establishment of a research collaboration capable of enriching the global health graduate program at the University of Alberta. Challenging questions about the long-term feasibility and sustainability of a community-based ARV program in Uganda still remain.
This project is a continuation of previous successful collaborations between the School of Public Health of Makerere University, the School of Public Health of University of Alberta, the Kabarole District Administration and the Kabarole Research and Resource Center.
在撒哈拉以南非洲地区，抗逆转录病毒疗法的可及性得到了提高，旨在使所有符合条件的 HIV 感染者受益；然而，实际上，抗逆转录病毒服务主要在城市医院提供。贫困的农村患者难以获得这些药物，导致抗逆转录病毒治疗的提供不平等。乌干达社区为基础的治疗方案的初步测试表明，艾滋病患者在家中接受治疗可能与在医院接受治疗效果相当；然而，文献中显示，此类方案的经验有限。
这项干预研究旨在：1）评估乌干达一个次县（Rwimi）的农村社区为基础的抗逆转录病毒治疗方案的效果；2）比较农村社区为基础的抗逆转录病毒治疗方案与成熟的医院为基础的方案的治疗结果和死亡率。加拿大和乌干达都获得了伦理批准。
在社区和医院队列中，两年后的成功治疗结果都很高。两个队列的全因死亡率相似。然而，社区为基础的患者更有可能实现病毒抑制，并且对治疗有良好的依从性。社区为基础的方案稍微更具成本效益。在这两个环境中，人均成本都不可持续，超过了乌干达初级卫生保健服务目前每年用于所有人的卫生服务的支出。在该项目评估的两年中，无偿的社区志愿者表现出了高参与率和低流失率。
这项研究的主要成功包括证明抗逆转录病毒治疗可以在农村地区提供，在卡巴罗莱卫生系统内建立了研究基础设施和文化，以及建立了一个能够丰富阿尔伯塔大学全球卫生研究生课程的研究合作关系。关于乌干达社区为基础的抗逆转录病毒方案的长期可行性和可持续性的具有挑战性的问题仍然存在。
该项目是马凯雷雷大学公共卫生学院、阿尔伯塔大学公共卫生学院、卡巴罗莱行政区和卡巴罗莱研究和资源中心之前成功合作的延续。
