When community health workers went looking for patients who had started antiretroviral treatment but had stopped showing up for care at 14 clinics across Uganda, Kenya and Tanzania, 13 percent of those sought returned to treatment. That represented a significant, if still small improvement over the 10 percent who returned for care when no effort to find them had been made.
But when researchers didn’t include in their count the numbers of patients who couldn’t be found, who had died, or who had started receiving treatment elsewhere — those, who, as they put it, couldn’t, or shouldn’t return to the clinic they had attended — the value of finding and talking to patients who had begun, but interrupted their treatment became clearer with 22 percent of those who could be found, and not in care elsewhere, returning to care.
The findings, in Clinical Infectious Diseases this week show the benefits that can be gained from an effort widely undertaken in low- and middle-income countries where community health workers and members of patient support groups, play a vital, but often unmeasured — and for that matter, often uncompensated or barely compensated — role in helping people diagnosed with HIV identify and overcome obstacles that include stigma, transportation challenges, poverty and other life circumstances, to receive and continue to receive the care they need. But, authors led by Anne Bershetyn of the Institute for Disease Modeling in Bellevue, Washington, also note the findings highlight a need to maximize those benefits by seeking data that, in turn, can help community health workers seek the right patients — those still living and still nearby.
The report on the findings is accompanied in the journal by a commentary by Dr. Wendy Armstrong and Dr. Carlos del Rio, both of Emory University, physicians who care for patients with HIV in the United States. They note that many of their patients face similar obstacles to those in the countries studied, and that the study “once again demonstrates that global innovations in HIV care in [low and middle income countries] have much to teach high-income countries; global lessons must be translated locally and vice versa.” They also note that high-income countries have an opportunity not only to benefit from the interventions effective in low-income countries, but also to improve links between hospitals and clinics and established state-level health information to increase the benefits of a proven intervention.