A new study from Uganda finds that home-based AIDS care is as effective as that delivered in a clinical setting and is considerably cheaper.
Researchers from the London School of Hygiene and Tropical Medicine, Boston University and several Ugandan institutions conducted the study, which chiefly involved subsistence farmers. The team assigned 859 patients to home care and 594 to facility care. All the patients had advanced AIDS. Those assigned to home-based care were visited by field officers on motorcycles who delivered drugs, offered counseling, and checked vital signs.
In each group, 11 percent of patients had died after one year. Sixteen percent of the home patients had virological failure, compared to 17 percent in facility care. Eleven percent of home patients were admitted at least once to a medical facility, compared to 13 percent in the facility care group.
Home-based care was slightly less expensive for the government but much less expensive for patients, as they did not have to pay transportation costs associated with visiting a clinic.
An accompanying editorial by Eline L. Korenromp and Kirsi M. Viisainen of the Global Fund to Fight AIDS, TB and Malaria noted that given the ever-increasing demand for AIDS treatment, cost-effectiveness evaluations are critical. It did caution that home visits by AIDS workers might be less acceptable in other parts of Africa, where HIV infection carries more stigma than in Uganda.
The study, "Rates of Virological Failure in Patients Treated in a Home-Based Versus a Facility-Based HIV-Care Model in Jinja, Southeast Uganda," and the editorial, "ART in Rural Uganda - Efficient Scale-Up with Home-Based Care?" were published online ahead of print in The Lancet (2009; doi:10.1016/S0140-6736(09)61674-3 and doi:10.1016/S0140-6736(09)62027-4).
11/24/09
UGANDA: Study in Rural Uganda Finds Benefits in Treating AIDS Patients at Home
Source: New York Times:: Donald G. McNeil Jr.; Courtesy of the CDC National Center for HIV, STD, and TB Prevention