@article {5361,
	title = {Community-Based Interventions to Improve and Sustain Antiretroviral Therapy Adherence, Retention in HIV Care and Clinical Outcomes in Low- and Middle-Income Countries for Achieving the UNAIDS 90-90-90 Targets.},
	journal = {Current HIV/AIDS reports},
	year = {2016},
	month = {2016 Jul 30},
	abstract = {Little is known about the effect of community versus health facility-based interventions to improve and sustain antiretroviral therapy (ART) adherence, virologic suppression, and retention in care among HIV-infected individuals in low- and middle-income countries (LMICs). We systematically searched four electronic databases for all available randomized controlled trials (RCTs) and comparative cohort studies in LMICs comparing community versus health facility-based interventions. Relative risks (RRs) for pre-defined adherence, treatment engagement (linkage and retention in care), and relevant clinical outcomes were pooled using random effect models. Eleven cohort studies and eleven RCTs (N = 97,657) were included. Meta-analysis of the included RCTs comparing community- versus health facility-based interventions found comparable outcomes in terms of ART adherence (RR = 1.02, 95~\% CI 0.99 to 1.04), virologic suppression (RR = 1.00, 95~\% CI 0.98 to 1.03), and all-cause mortality (RR = 0.93, 95~\% CI 0.73 to 1.18). The result of pooled analysis from the RCTs (RR = 1.03, 95~\% CI 1.01 to 1.06) and cohort studies (RR = 1.09, 95~\% CI 1.03 to 1.15) found that participants assigned to community-based interventions had statistically significantly higher rates of treatment engagement. Two studies found community-based ART delivery model either cost-saving or cost-effective. Community- versus facility-based models of ART delivery resulted in at least comparable outcomes for clinically stable HIV-infected patients on treatment in LMICs and are likely to be cost-effective.},
	issn = {1548-3576},
	doi = {10.1007/s11904-016-0325-9 },
	author = {Nachega, Jean B and Adetokunboh, Olatunji and Uthman, Olalekan A and Knowlton, Amy W and Altice, Frederick L and Schechter, Mauro and Gal{\'a}rraga, Omar and Geng, Elvin and Peltzer, Karl and Chang, Larry W and Van Cutsem, Gilles and Jaffar, Shabbar S and Ford, Nathan and Mellins, Claude A and Remien, Robert H and Mills, Edward J}
}
