Date Published: September 20, 2017
Author(s): Bismark Sarfo, Naa Ashiley Vanderpuye, Abigail Addison, Peter Nyasulu.
Factors associated with individual patient-level management of HIV have received minimal attention in sub-Saharan Africa. This study determined the association between support services and cluster of differentiation 4 (CD4) counts among HIV patients attending ART clinic in Ghana.
This was a cross-sectional study involving adults with HIV recruited between 1 August 2014 and 31 January 2015. Data on support services were obtained through a closed-ended personal interview while the CD4 counts data were collected from their medical records. Data were entered into EpiData and analyzed using Stata software.
Of the 201 patients who participated in the study, 67% (129/191) received case management support service. Counseling about how to prevent the spread of HIV (crude odds ratio (cOR) (95% confidence interval (CI)) (2.79 (1.17–6.68)), mental health services (0.2 (0.04–1.00)), and case management support service (2.80 (1.34–5.82))) was associated with improved CD4 counts of 350 cells/mm3 or more. After adjusting for counseling about how to prevent the spread of HIV and mental health services, case management support service was significantly associated with CD4 counts of 350 cells/mm3 or more (aOR = 2.36 (CI = 1.01–5.49)).
Case management support service for HIV patients receiving ART improves their CD4 counts above 350 cells/mm3. Incorporating HIV case management services in ART regimen should be a priority in sub-Saharan Africa.
Although sub-Saharan Africa remains the home to most of new HIV infections , there is limited attention observed in terms of care and support provided to persons with HIV/AIDS over and above antiretroviral treatment (ART) programs. Case management support service is a special kind of service model that is usually provided to HIV patients and it consists of the provision of support services to clients and establishing a special relationship and communication between HIV service providers and their clients [2, 3]. This ensures efficient coordination in the provision of medical care and social support services to patients. Ultimately, the goal of case management support services is to effectively engage and retain patients and ensure good adherence to medication and treatment as a whole [4, 5].
Two hundred and one (N = 201) HIV patients participated in the study. The mean age for males and females was 44.8 (SD ± 10.25) and 38.3 (SD ± 9.78) years, respectively (Table 1). Most of the participants were between 31 and 45 years (111/197; 56.3%) and over 51.7% (90/174) of them were married. There were more female participants (152/201; 75.6%) than males (49/201; 24.4%) in the study group (Table 2). Most of the participants had attained junior high school education (89/200; 44.5%). Greater proportion of the participants (121/193; 62.7%) were self-employed (Table 2). For support services that participants had received 12 months prior to the study, the majority (67.5% (129/191)) had received some form of case management for their treatment and counseling (80.6% (154/191)) about how to prevent the spread of HIV. Only 32.1% (62/193) have received nutritional services and 4.1% (8/194) had received mental health services (Table 3).
This study has demonstrated that, beyond ART regimen, supporting people living with HIV (PLWH) in managing their associated problems improves their CD4 counts level.
Patients on ART who received case management support service have improved CD4 count of 350 cells/mm3 or more. Incorporating HIV/AIDS case management services in ART regimen should be a priority in sub-Saharan Africa.