Community-based DOT-HAART accompaniment in an urban resource-poor setting

Area of Science:

• Public Health
• Infectious Diseases
• Social Sciences

Background:

• Antiretroviral therapy (ART) adherence is critical for managing HIV/AIDS.
• Community-based support models can potentially improve treatment outcomes in resource-limited settings.

Purpose of the Study:

• To evaluate the effectiveness of a community-based accompaniment with supervised antiretroviral (CASA) program.
• To compare clinical and psychosocial outcomes between CASA participants and a control group.

Main Methods:

• A cohort study enrolled 60 adults starting ART in Lima, Peru, receiving twice-daily home visits for directly observed therapy and support.
• A matched control group of 60 individuals from a neighboring district was established.
• Validated instruments assessed depression, social support, quality of life, HIV-related stigma, and self-efficacy at baseline and 12 months.

Main Results:

• CASA participants demonstrated improved clinical outcomes, including a higher proportion achieving virologic suppression.
• Significant improvements were observed in psychosocial outcomes for the CASA group, such as increased social support and reduced HIV-associated stigma.
• Enhanced self-efficacy and quality of life were also noted in the CASA intervention group.

Conclusions:

• Community-based accompaniment with supervised antiretroviral (CASA) is an effective intervention for improving both clinical and psychosocial outcomes in adults initiating ART.
• The CASA model, integrating direct observation with comprehensive support, offers a promising strategy for enhancing HIV treatment adherence and patient well-being.