| Home-based ART delivery is as effective as clinic-based care in Sub-Saharan Africa |
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Trained lay workers delivering ART to people in their homes are just as effective as doctors and nurses based in clinics, according to the results of the Jinja trial. This trial was carried out in Jinja district of Uganda by MRC/UVRI, LSHTM, TASO, CDC and Ministry of Health in Uganda. These findings could have major implications for how to deliver HIV treatment where clinical staff are scarce and patient access to clinics is difficult. Antiretroviral therapy in Uganda is currently available through public hospitals, which are located in urban areas. For people living outside the cities this often means long and expensive journeys to collect their drugs each month. The average cost of accessing treatment in Jinja district of Uganda is around 13-20% of patients’ monthly income. This is the equivalent of people in Europe having to pay for a long-haul flight each month to collect drugs. The trial looked at whether trained field officers without medical qualifications, travelling on motorbikes, could deliver ART to the homes of patients, monitor them for side-effects and disease progression, and support them to stick to their treatment. There were worries that using lay workers, rather than doctors and nurses, would compromise patient safety, and not be cost-effective. The results showed that trained field officers delivering antiretroviral therapy to people’s homes are just as effective and safe as doctors and nurses based in clinics. Delivering treatment this way is also no more expensive to the health system than through clinics. Importantly for patients, the costs to them were much lower than if they had to visit the clinic every month. Home-based HIV care with ART is an effective and feasible strategy which provides immense savings for patients. Community-based strategies like this could enable increased and equitable access to HIV treatment. More work is needed to:
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