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HIV Treatment In Basic Health Facilities – Fewer Patients Lost And Quality Of Care Maintained, Recent Cochrane Review Shows

Treating in or at home means fewer patients drop out of treatment but the quality of care doesn’t suffer, a published this month shows. The review brought together the results of 16 studies, mostly conducted in countries in Africa and included both children and adults on antiretrovirals. The results found that treating patients closer to home rather than at a hospital, either at a basic health facility in the community, resulted in more patients continuing on their treatment without compromising the quality of care they received, and was prepared by an international collaboration of scientists led by a team from South Africa.

Starting HIV patients and continuing patients on treatment at peripheral clinics and in the communities is a new recommendation made by the made this week, drawing on the results of this review. “The WHO recommends decentralisation of initiation and maintenance of ART to peripheral health centres, and maintenance of ART at community level between clinic visits,” says Eyerusalem Negussie from the WHO guideline development group. “The shows that decentralisation of ART to health centres and community level improves retention in care, and provides non inferiority comparable care compared to services provided at hospital level.” WHO have included this recommendation in their new consolidated HIV guidelines issued at the International Aids Society Conference in Kuala Lumpur, Malaysia this week.

Medical coordinator with MSF / Doctors Without Borders for South Africa and Lesotho , Gilles Van Cutsem says the review confirms what MSF has been implementing on its projects and advocating for several years. “To scale up access to ART without messing up, and losing patients, it is necessary to bring treatment as close to patients as possible,” he says, “whilst decentralization to primary care is essential, the future of ART programmes involves delivery of antiretroviral drugs at community level. The review is an important summary of existing evidence supporting the new WHO guidelines.”

The World Health Organization (WHO) launched its consolidated guidelines for treating and preventing HIV at the International Aids Society Conference in Kuala Lumpur, Malaysia this week. These Guidelines go beyond recommendations for treatment and provide evidence on operations and service delivery.

Researchers from the South African Cochrane Centre, Liverpool School of Tropical Medicine (LSTM) and Médecins Sans Frontières (MSF) were part of a team commissioned to conduct a systematic review of the current evidence to inform these guidelines. This was in collaboration with the Cochrane HIV/AIDS Review Group, based at the University of California, San Francisco.

The Cochrane Review process is widely recognised as the most rigorous way of collating the evidence to provide the necessary information to assist policy making.


The review, ‘Decentralising in lower- and middle-income countries’ was published on 27 June in The Cochrane Library.
The Cochrane review can be accessed through The Cochrane Library

SA Medical Research Council