Skip to main content
Erschienen in: AIDS and Behavior 5/2016

07.09.2015 | Original Paper

Community-Based Accompaniment Mitigates Predictors of Negative Outcomes for Adults on Antiretroviral Therapy in Rural Rwanda

verfasst von: Neil Gupta, Christian Munyaburanga, Mwumvaneza Mutagoma, John W. Niyigena, Felix Kayigamba, Molly F. Franke, Bethany Hedt-Gauthier

Erschienen in: AIDS and Behavior | Ausgabe 5/2016

Einloggen, um Zugang zu erhalten

Abstract

Clinical, socioeconomic, and access barriers remain a critical problem to antiretroviral (ART) programs in sub-Saharan Africa. Community-based accompaniment (CBA), including daily home visits and psychosocial and socioeconomic support, has been associated with improved patient outcomes at 1 year. We conducted a prospective observational cohort study of 578 HIV-infected adults initiating ART in 2007–2008 with or without CBA in rural Rwanda. Among patients without CBA, those with advanced HIV disease, low CD4 cell counts, lower social support, and transport costs had significantly higher odds of negative outcomes at 1 year; amongst patients who received CBA, only those with low CD4 cell counts had significantly higher odds of negative outcomes at 1 year. CBA also significantly mitigated the effect of transport costs and inaccessibility of services on the likelihood of negative outcome. CBA may be one approach to mitigating known risk factors for negative outcomes for patients on ART in resource-poor settings.
Literatur
1.
Zurück zum Zitat Fox MP, Rosen S. Patient retention in antiretroviral therapy programs up to 3 years on treatment in sub-Saharan Africa, 2007–2009: systematic review. Trop Med Int Health. 2010;15(Suppl 1):1–15.CrossRefPubMedPubMedCentral Fox MP, Rosen S. Patient retention in antiretroviral therapy programs up to 3 years on treatment in sub-Saharan Africa, 2007–2009: systematic review. Trop Med Int Health. 2010;15(Suppl 1):1–15.CrossRefPubMedPubMedCentral
2.
Zurück zum Zitat Barth RE, van der Loeff MFS, Schuurman R, Hoepelman AI, Wensing AM. Virological follow-up of adult patients in antiretroviral treatment programmes in sub-Saharan Africa: a systematic review. Lancet Infect Dis. 2010;10:155–66.CrossRefPubMed Barth RE, van der Loeff MFS, Schuurman R, Hoepelman AI, Wensing AM. Virological follow-up of adult patients in antiretroviral treatment programmes in sub-Saharan Africa: a systematic review. Lancet Infect Dis. 2010;10:155–66.CrossRefPubMed
3.
Zurück zum Zitat Mills EJ, Nachega JB, Bangsberg DR, Singh S, Rachlis B, Wu P, et al. Adherence to HAART: a systematic review of developed and developing nation patient-reported barriers and facilitators. PLoS Med. 2006;3:2039–64. Mills EJ, Nachega JB, Bangsberg DR, Singh S, Rachlis B, Wu P, et al. Adherence to HAART: a systematic review of developed and developing nation patient-reported barriers and facilitators. PLoS Med. 2006;3:2039–64.
4.
Zurück zum Zitat Joint United Nations Program on HIV/AIDS (UNAIDS). The gap report. Geneva: Joint United Nations Program on HIV/AIDS; 2014. Joint United Nations Program on HIV/AIDS (UNAIDS). The gap report. Geneva: Joint United Nations Program on HIV/AIDS; 2014.
5.
Zurück zum Zitat Decroo T, Rasschaert F, Telfer B, Remartinez D, Laga M, Ford N. Community-based antiretroviral therapy programs can overcome barriers to retention of patients and decongest health services in sub-Saharan Africa: a systematic review. Int Health. 2013;5:169–79.CrossRefPubMed Decroo T, Rasschaert F, Telfer B, Remartinez D, Laga M, Ford N. Community-based antiretroviral therapy programs can overcome barriers to retention of patients and decongest health services in sub-Saharan Africa: a systematic review. Int Health. 2013;5:169–79.CrossRefPubMed
6.
Zurück zum Zitat World Health Organization. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach. Geneva: World Health Organization; 2013. World Health Organization. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach. Geneva: World Health Organization; 2013.
7.
Zurück zum Zitat Franke MF, Kaigamba F, Socci AR, Hakizamungu M, Patel A, Bagiruwigize E, et al. Improved retention associated with community-based accompaniment for antiretroviral therapy delivery in rural Rwanda. Clin Infect Dis. 2013;56:1319–26.CrossRefPubMed Franke MF, Kaigamba F, Socci AR, Hakizamungu M, Patel A, Bagiruwigize E, et al. Improved retention associated with community-based accompaniment for antiretroviral therapy delivery in rural Rwanda. Clin Infect Dis. 2013;56:1319–26.CrossRefPubMed
8.
Zurück zum Zitat Muñoz M, Finnegan K, Zeladita J, Caldas A, Sanchez E, Callacna M, et al. Community-based DOT-HAART accompaniment in an urban resource-poor setting. AIDS Behav. 2010;14:721–30.CrossRefPubMed Muñoz M, Finnegan K, Zeladita J, Caldas A, Sanchez E, Callacna M, et al. Community-based DOT-HAART accompaniment in an urban resource-poor setting. AIDS Behav. 2010;14:721–30.CrossRefPubMed
9.
Zurück zum Zitat Thomson DR, Rich ML, Kaigamba F, Socci AR, Hakizamungu M, Bagiruwigize E, et al. Community-based accompaniment and psychosocial health outcomes in HIV-infected adults in Rwanda: a prospective study. AIDS Behav. 2014;18:368–80.CrossRefPubMed Thomson DR, Rich ML, Kaigamba F, Socci AR, Hakizamungu M, Bagiruwigize E, et al. Community-based accompaniment and psychosocial health outcomes in HIV-infected adults in Rwanda: a prospective study. AIDS Behav. 2014;18:368–80.CrossRefPubMed
10.
Zurück zum Zitat National Institute of Statistics Rwanda. Census and housing report. Kigali: National Institute of Statistics; 2012. National Institute of Statistics Rwanda. Census and housing report. Kigali: National Institute of Statistics; 2012.
11.
Zurück zum Zitat The Republic of Rwanda. Economic development and poverty reduction strategy: 2013–2018. Kigali: Republic of Rwanda; 2013. The Republic of Rwanda. Economic development and poverty reduction strategy: 2013–2018. Kigali: Republic of Rwanda; 2013.
12.
Zurück zum Zitat The Ministry of Health of Rwanda. Third health system strategic plan III: July 2012–June 2018. Kigali: Rwanda Ministry of Health; 2012. The Ministry of Health of Rwanda. Third health system strategic plan III: July 2012–June 2018. Kigali: Rwanda Ministry of Health; 2012.
13.
Zurück zum Zitat Logia DE, Rowson M, Ndagije F. Innovations in Rwanda’s health system: looking to the future. Lancet. 2008;372:256–61.CrossRef Logia DE, Rowson M, Ndagije F. Innovations in Rwanda’s health system: looking to the future. Lancet. 2008;372:256–61.CrossRef
14.
Zurück zum Zitat Ministry of Health of Rwanda, National Institute of Statistics of Rwanda and IFC Macro. Rwanda demographic and health survey 2010. Calverton, MD: MOH, NISR, and IFC Macro; 2011. Ministry of Health of Rwanda, National Institute of Statistics of Rwanda and IFC Macro. Rwanda demographic and health survey 2010. Calverton, MD: MOH, NISR, and IFC Macro; 2011.
15.
Zurück zum Zitat Rwanda Biomedical Center. Annual report: July 2010–June 2011. Kigali: Rwanda Biomedical Center; 2012. Rwanda Biomedical Center. Annual report: July 2010–June 2011. Kigali: Rwanda Biomedical Center; 2012.
16.
Zurück zum Zitat Rwanda Ministry of Health. Guide pour la Prise en Charge Therapeutique du VIH/SIDA. Kigali: Rwanda Ministry of Health; 2005. Rwanda Ministry of Health. Guide pour la Prise en Charge Therapeutique du VIH/SIDA. Kigali: Rwanda Ministry of Health; 2005.
17.
Zurück zum Zitat Rich ML, Miller AC, Niyigena P, Franke MF, Niyonzima JB, Socci A, et al. Excellent clinical outcomes and high retention in care among adults in a community-based HIV treatment program in rural Rwanda. J Acquir Immune Defic Syndr. 2012;59:e35–42.CrossRefPubMed Rich ML, Miller AC, Niyigena P, Franke MF, Niyonzima JB, Socci A, et al. Excellent clinical outcomes and high retention in care among adults in a community-based HIV treatment program in rural Rwanda. J Acquir Immune Defic Syndr. 2012;59:e35–42.CrossRefPubMed
18.
Zurück zum Zitat Merkel E, Gupta N, Nyirimana A, Niyonsenga SP, Nahimana E, Stulac S, et al. Clinical outcomes among HIV-positive adolescents attending an integrated and comprehensive adolescent-focused HIV care program in rural Rwanda. J HIV AIDS Soc Serv. 2013;12:437–50.CrossRef Merkel E, Gupta N, Nyirimana A, Niyonsenga SP, Nahimana E, Stulac S, et al. Clinical outcomes among HIV-positive adolescents attending an integrated and comprehensive adolescent-focused HIV care program in rural Rwanda. J HIV AIDS Soc Serv. 2013;12:437–50.CrossRef
19.
Zurück zum Zitat Epino HM, Rich ML, Kaigamba F, Hakizamungu M, Socci A, Bagiruwigize E, et al. Reliability and construct validity of three health-related self-report scales in HIV-positive adults in rural Rwanda. AIDS Care. 2012;24:1576–83.CrossRefPubMed Epino HM, Rich ML, Kaigamba F, Hakizamungu M, Socci A, Bagiruwigize E, et al. Reliability and construct validity of three health-related self-report scales in HIV-positive adults in rural Rwanda. AIDS Care. 2012;24:1576–83.CrossRefPubMed
20.
Zurück zum Zitat Broadhead WE, Gehlbach SH, de Gruy FV, Kaplan BH. The Duke-UNC Functional Social Support Questionnaire: measurement of social support in family medicine patients. Med Care. 1988;26:709–23.CrossRefPubMed Broadhead WE, Gehlbach SH, de Gruy FV, Kaplan BH. The Duke-UNC Functional Social Support Questionnaire: measurement of social support in family medicine patients. Med Care. 1988;26:709–23.CrossRefPubMed
21.
Zurück zum Zitat Coates J, Swindale A, Bilinsky P. Household food insecurity access scale (HFIAS) for measurement of household food access: indicator guide (v. 3). Washington, D.C.: Food and Nutrition Technical Assistance Project, Academy for Educational Development; 2007. Coates J, Swindale A, Bilinsky P. Household food insecurity access scale (HFIAS) for measurement of household food access: indicator guide (v. 3). Washington, D.C.: Food and Nutrition Technical Assistance Project, Academy for Educational Development; 2007.
22.
Zurück zum Zitat Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Washington, D.C.: Department of Health and Human Services; 2011. Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Washington, D.C.: Department of Health and Human Services; 2011.
23.
Zurück zum Zitat Egger M, May M, Chêne G, Phillips AN, Ledergerber B, Debis F, et al. Prognosis of HIV-1-infected patients starting highly active antiretroviral therapy: a collaborative analysis of prospective studies. Lancet. 2002;360:119–29.CrossRefPubMed Egger M, May M, Chêne G, Phillips AN, Ledergerber B, Debis F, et al. Prognosis of HIV-1-infected patients starting highly active antiretroviral therapy: a collaborative analysis of prospective studies. Lancet. 2002;360:119–29.CrossRefPubMed
24.
Zurück zum Zitat Lundgren JD, Mocroft A, Gatell JM, Ledergerber B, Monforte AD, Hermans P, et al. A clinically prognostic scoring system for patients receiving highly active antiretroviral therapy: results from the EuroSIDA study. J Infect Dis. 2002;185:178–87.CrossRefPubMed Lundgren JD, Mocroft A, Gatell JM, Ledergerber B, Monforte AD, Hermans P, et al. A clinically prognostic scoring system for patients receiving highly active antiretroviral therapy: results from the EuroSIDA study. J Infect Dis. 2002;185:178–87.CrossRefPubMed
25.
Zurück zum Zitat May M, Boulle A, Phiri S, Messou E, Myer L, Wood R, et al. Prognosis of patients with HIV-1 infection starting antiretroviral therapy in sub-Saharan Africa: a collaborative analysis of scale-up programmes. Lancet. 2010;376:449–57.CrossRefPubMedPubMedCentral May M, Boulle A, Phiri S, Messou E, Myer L, Wood R, et al. Prognosis of patients with HIV-1 infection starting antiretroviral therapy in sub-Saharan Africa: a collaborative analysis of scale-up programmes. Lancet. 2010;376:449–57.CrossRefPubMedPubMedCentral
26.
Zurück zum Zitat Kabore I, Bloem J, Etheredge G, Obiero W, Wanless S, Doykos P, et al. The effect of community-based support services on clinical efficacy and health-related quality of life in HIV/AIDS patients in resource-limited settings in sub-Saharan Africa. AIDS Patient Care STDS. 2010;24:581–94.CrossRefPubMed Kabore I, Bloem J, Etheredge G, Obiero W, Wanless S, Doykos P, et al. The effect of community-based support services on clinical efficacy and health-related quality of life in HIV/AIDS patients in resource-limited settings in sub-Saharan Africa. AIDS Patient Care STDS. 2010;24:581–94.CrossRefPubMed
27.
Zurück zum Zitat Bärnighausen T, Chaiyachati K, Chimbindi N, Peoples A, Haberer J, Newell M, et al. Interventions to increase antiretroviral adherence in sub-Saharan Africa: a systematic review of evaluation studies. Lancet Infect Dis. 2011;11:942–51.CrossRefPubMedPubMedCentral Bärnighausen T, Chaiyachati K, Chimbindi N, Peoples A, Haberer J, Newell M, et al. Interventions to increase antiretroviral adherence in sub-Saharan Africa: a systematic review of evaluation studies. Lancet Infect Dis. 2011;11:942–51.CrossRefPubMedPubMedCentral
28.
Zurück zum Zitat Pearson CR, Micek MA, Simoni JM, Hoff PD, Matediana E, Martin DP, et al. Randomized control trial of peer-delivered, modified directly observed therapy for HAART in Mozambique. J Acquir Immune Defic Syndr. 2007;46:238–44.CrossRefPubMedPubMedCentral Pearson CR, Micek MA, Simoni JM, Hoff PD, Matediana E, Martin DP, et al. Randomized control trial of peer-delivered, modified directly observed therapy for HAART in Mozambique. J Acquir Immune Defic Syndr. 2007;46:238–44.CrossRefPubMedPubMedCentral
29.
Zurück zum Zitat Taiwo BO, Idoko JA, Welty LJ, Ihedinachi O, Job G, Iyaji PG, et al. Assessing the virologic and adherence benefits of patient-selected HIV treatment partners in a resource-limited setting. J Acquir Immune Defic Syndr. 2010;54:85–92.CrossRefPubMed Taiwo BO, Idoko JA, Welty LJ, Ihedinachi O, Job G, Iyaji PG, et al. Assessing the virologic and adherence benefits of patient-selected HIV treatment partners in a resource-limited setting. J Acquir Immune Defic Syndr. 2010;54:85–92.CrossRefPubMed
30.
Zurück zum Zitat Stubbs BA, Micek MA, Pfeiffer JT, Montoya P, Gloyd S. Treatment partners and adherence to HAART in central Mozambique. AIDS Care. 2009;21:1412–9.CrossRefPubMed Stubbs BA, Micek MA, Pfeiffer JT, Montoya P, Gloyd S. Treatment partners and adherence to HAART in central Mozambique. AIDS Care. 2009;21:1412–9.CrossRefPubMed
31.
Zurück zum Zitat Sarna A, Luchters S, Geibel S, Chersich MF, Munyao P, Kaai S, et al. Short- and long-term efficacy of modified directly observed antiretroviral treatment in Mombasa, Kenya: a randomized trial. J Acquir Immune Defic Syndr. 2008;48:611–9.CrossRefPubMed Sarna A, Luchters S, Geibel S, Chersich MF, Munyao P, Kaai S, et al. Short- and long-term efficacy of modified directly observed antiretroviral treatment in Mombasa, Kenya: a randomized trial. J Acquir Immune Defic Syndr. 2008;48:611–9.CrossRefPubMed
32.
Zurück zum Zitat Chang LW, Kagaayi J, Nakigozi G, Ssemijja V, Packer AH, Serwadda D, et al. Effect of peer health workers on AIDS care in Rakai, Uganda: a cluster-randomized trial. PLoS ONE. 2010;5:e10923.CrossRefPubMedPubMedCentral Chang LW, Kagaayi J, Nakigozi G, Ssemijja V, Packer AH, Serwadda D, et al. Effect of peer health workers on AIDS care in Rakai, Uganda: a cluster-randomized trial. PLoS ONE. 2010;5:e10923.CrossRefPubMedPubMedCentral
33.
Zurück zum Zitat Nachega JB, Chaisson RE, Goliath R, Efron A, Chaudhary MA, Ram M, et al. Randomized controlled trial of trained patient-nominated treatment supporters providing partial directly observed antiretroviral therapy. AIDS. 2010;24:1273–80.PubMedPubMedCentral Nachega JB, Chaisson RE, Goliath R, Efron A, Chaudhary MA, Ram M, et al. Randomized controlled trial of trained patient-nominated treatment supporters providing partial directly observed antiretroviral therapy. AIDS. 2010;24:1273–80.PubMedPubMedCentral
34.
Zurück zum Zitat Ramadhani HO, Thielman NM, Landman KZ, Ndosi EM, Gao F, Kirchherr JL, et al. Predictors of incomplete adherence, virologic failure, and antiviral drug resistance among HIV-infected adults receiving antiretroviral therapy in Tanzania. Clin Infect Dis. 2007;45:1492–8.CrossRefPubMed Ramadhani HO, Thielman NM, Landman KZ, Ndosi EM, Gao F, Kirchherr JL, et al. Predictors of incomplete adherence, virologic failure, and antiviral drug resistance among HIV-infected adults receiving antiretroviral therapy in Tanzania. Clin Infect Dis. 2007;45:1492–8.CrossRefPubMed
35.
Zurück zum Zitat Posse M, Baltussen R. Barriers to access to antiretroviral treatment in Mozambique, as perceived by patients and health workers in urban and rural settings. AIDS Patient Care STDS. 2009;23:867–75.CrossRefPubMed Posse M, Baltussen R. Barriers to access to antiretroviral treatment in Mozambique, as perceived by patients and health workers in urban and rural settings. AIDS Patient Care STDS. 2009;23:867–75.CrossRefPubMed
36.
Zurück zum Zitat Mshana GH, Wamoyi J, Busza J, Zaba B, Changalucha J, Kaluvya S, et al. Barriers to accessing antiretroviral therapy in Kisses, Tanzania: a qualitative study of early rural referrals to the national program. AIDS Patient Care STDS. 2006;20:649–57.CrossRefPubMed Mshana GH, Wamoyi J, Busza J, Zaba B, Changalucha J, Kaluvya S, et al. Barriers to accessing antiretroviral therapy in Kisses, Tanzania: a qualitative study of early rural referrals to the national program. AIDS Patient Care STDS. 2006;20:649–57.CrossRefPubMed
37.
Zurück zum Zitat Dlamini PS, Wantland D, Makoae LN, Chirwa M, Kohi TW, Greeff M, et al. HIV stigma and missed medications in HIV-positive people in five African countries. AIDS Patient Care STDS. 2009;23:377–87.CrossRefPubMedPubMedCentral Dlamini PS, Wantland D, Makoae LN, Chirwa M, Kohi TW, Greeff M, et al. HIV stigma and missed medications in HIV-positive people in five African countries. AIDS Patient Care STDS. 2009;23:377–87.CrossRefPubMedPubMedCentral
38.
Zurück zum Zitat Shin S, Muñoz M, Zeladita J, Slavin S, Caldas A, Sanchez E, et al. How does directly observed therapy work? The mechanisms and impact of a comprehensive directly observed therapy intervention of highly active antiretroviral therapy in Peru. Health Soc Care Community. 2011;19:261–71.CrossRefPubMed Shin S, Muñoz M, Zeladita J, Slavin S, Caldas A, Sanchez E, et al. How does directly observed therapy work? The mechanisms and impact of a comprehensive directly observed therapy intervention of highly active antiretroviral therapy in Peru. Health Soc Care Community. 2011;19:261–71.CrossRefPubMed
39.
Zurück zum Zitat Behforouz HL, Farmer PE, Mukherjee JS. From directly observed therapy to accompagnateurs: enhancing AIDS treatment outcomes in Haiti and in Boston. Clin Infect Dis. 2004;38:S429–36.CrossRefPubMed Behforouz HL, Farmer PE, Mukherjee JS. From directly observed therapy to accompagnateurs: enhancing AIDS treatment outcomes in Haiti and in Boston. Clin Infect Dis. 2004;38:S429–36.CrossRefPubMed
40.
Zurück zum Zitat Williams AB, Fennie KP, Bova CA, Burgess JD, Danvers KA, Dieckhaus KD. Home visits to improve adherence to highly active antiretroviral therapy: a randomized controlled trial. J Acquir Immune Defic Syndr. 2006;42:314–21.CrossRefPubMed Williams AB, Fennie KP, Bova CA, Burgess JD, Danvers KA, Dieckhaus KD. Home visits to improve adherence to highly active antiretroviral therapy: a randomized controlled trial. J Acquir Immune Defic Syndr. 2006;42:314–21.CrossRefPubMed
41.
Zurück zum Zitat Mukherjee JS, Ivers L, Leandre F, Farmer P, Behforouz H. Antiretroviral therapy in resource-poor settings decreasing barriers to access and promoting adherence. J Acquir Immune Defic Syndr. 2006;43:S123–6.CrossRefPubMed Mukherjee JS, Ivers L, Leandre F, Farmer P, Behforouz H. Antiretroviral therapy in resource-poor settings decreasing barriers to access and promoting adherence. J Acquir Immune Defic Syndr. 2006;43:S123–6.CrossRefPubMed
42.
Zurück zum Zitat Ware NC, Idoko J, Kaaya S, Biraro IA, Wyatt MA, Agbaji O, et al. Explaining adherence success in sub-Saharan Africa: an ethnographic study. PLoS Med. 2009;6:e11.CrossRefPubMed Ware NC, Idoko J, Kaaya S, Biraro IA, Wyatt MA, Agbaji O, et al. Explaining adherence success in sub-Saharan Africa: an ethnographic study. PLoS Med. 2009;6:e11.CrossRefPubMed
43.
Zurück zum Zitat O’Laughlin KN, Wyatt MA, Kaaya S, Bangsberg DR, Ware NC. How treatment partners help: social analysis of an African adherence support intervention. AIDS Behav. 2012;16:1308–15.CrossRefPubMedPubMedCentral O’Laughlin KN, Wyatt MA, Kaaya S, Bangsberg DR, Ware NC. How treatment partners help: social analysis of an African adherence support intervention. AIDS Behav. 2012;16:1308–15.CrossRefPubMedPubMedCentral
44.
Zurück zum Zitat Dhillon RS, Bonds MH, Fraden M, Ndahiro D, Ruxin J. The impact of reducing financial barriers on utilisation of a primary health care facility in Rwanda. Glob Public Health. 2012;7:71–86.CrossRefPubMedPubMedCentral Dhillon RS, Bonds MH, Fraden M, Ndahiro D, Ruxin J. The impact of reducing financial barriers on utilisation of a primary health care facility in Rwanda. Glob Public Health. 2012;7:71–86.CrossRefPubMedPubMedCentral
45.
Zurück zum Zitat Hardon AP, Akurut D, Comoro C, Ekezie C, Irunde HF, Gerrits T, et al. Hunger, waiting time and transport costs: time to confront challenges to ART adherence in Africa. AIDS Care. 2007;19:658–65.CrossRefPubMed Hardon AP, Akurut D, Comoro C, Ekezie C, Irunde HF, Gerrits T, et al. Hunger, waiting time and transport costs: time to confront challenges to ART adherence in Africa. AIDS Care. 2007;19:658–65.CrossRefPubMed
46.
Zurück zum Zitat Weiser S, Wolfe W, Bangsberg D, Thior I, Gilbert P, Makhema J, et al. Barriers to antiretroviral adherence for patients living with HIV infection and AIDS in Botswana. J Acquir Immune Defic Syndr. 2003;34:281–8.CrossRefPubMed Weiser S, Wolfe W, Bangsberg D, Thior I, Gilbert P, Makhema J, et al. Barriers to antiretroviral adherence for patients living with HIV infection and AIDS in Botswana. J Acquir Immune Defic Syndr. 2003;34:281–8.CrossRefPubMed
Metadaten
Titel
Community-Based Accompaniment Mitigates Predictors of Negative Outcomes for Adults on Antiretroviral Therapy in Rural Rwanda
verfasst von
Neil Gupta
Christian Munyaburanga
Mwumvaneza Mutagoma
John W. Niyigena
Felix Kayigamba
Molly F. Franke
Bethany Hedt-Gauthier
Publikationsdatum
07.09.2015
Verlag
Springer US
Erschienen in
AIDS and Behavior / Ausgabe 5/2016
Print ISSN: 1090-7165
Elektronische ISSN: 1573-3254
DOI
https://doi.org/10.1007/s10461-015-1185-9

Weitere Artikel der Ausgabe 5/2016

AIDS and Behavior 5/2016 Zur Ausgabe

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.