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Objective: Community-based antiretroviral treatment (CBART) programs should aim to achieve positive quality of life outcomes. The purpose of this study was to investigate changes in the health related quality of life (HRQOL) outcomes of patients in a CBART program supported by community volunteers in one sub-county in western Uganda located 50 km from the nearest urban centre. Methods: We administered a translated version of the MOS-HIV survey and collected clinical data at baseline and after one year from 130 patients. Inclusion criteria included residency in the sub-county, eighteen years of age or, treatmentnaive, eligible for ART based on CD4 cell count <200 cells/mm3 or WHO clinical stage 3 or 4, and willing to accept daily treatment support by family/friends and to be visited by a community volunteer weekly. We assessed changes in physical health (PHS) and mental health (MHS) summary scores and examined associations between patient characteristics and changes in HRQOL. Results: After one year, we observed significant increases in mean PHS (42.7 to 50.1; p<0.01) and MHS (43.5 to 49.5; p<0.01) scores. Lower age (p<0.01) and lower baseline PHS scores (p<0.01) were associated with increases in PHS scores and lower age (p0.03) and lower baseline MHS scores (p<0.01) were associated with increases in MHS scores. Fifteen patients (12) had reductions in their HRQOL after one year which were not associated with patient or clinical characteristics, including virological suppression. Conclusions: The observed improvements in HRQOL demonstrate that positive treatment outcomes can be achieved in CBART programs in rural Uganda. However, some patients appear to experience declines in their overall well-being, despite achieving virological suppression. HRQOL surveys can be useful in identifying these patients, who may require additional attention and support to achieve the full benefits of ART.

Objective: To compare the treatment outcomes and mortality in a rural community-based ART (CBART) program with a hospital-based ART program in the same district. Methods: The study design was a non-randomized cohort study consisting of 185 persons living with HIV (PLWHIV) in the CBART cohort and 200 PLWHIV in the hospital cohort. Eligibility for both cohorts was: being HIV-infected and eligible for ART, being treatment naive, age 18 years or older, and being a resident of Rwimi sub-county. The intervention consisted of a community-based program which included weekly home visits to patients by trained volunteers who delivered antiretroviral drugs (ARVs), monitored and supported adherence to treatment, and identified and reported adverse reactions and other clinical symptoms. Outcome variables were compared to patients in a hospital-based cohort who received the standard care delivered to all other HIV patients in the hospital. The main outcome measures were HIV- 1 RNA viral load (VL), CD4 cell count and mortality after six months of treatment. Results: Successful ART treatment outcome as measured by virological suppression (VL<400 copies/ml) in the CBART cohort was similar to those in the hospital-based cohort (90.1 vs 89.3, p0.47). The median CD4 cell count increased significantly in both cohorts (community-based cohort 159 cells/l vs 145 cells/l in the hospital-based cohort). Mortality was not significantly different in both cohorts (community-based cohort 11.9, hospital-based cohort 9.0). Conclusion: The findings show that outcomes of a CBART intervention in a rural area compare favorably to outcomes of hospital-based care. If the study results are sustainable over a longer time period, this model could be considered for ART roll-out to impoverished rural/remote populations in Uganda and elsewhere.

The vast majority of patients with epilepsy in developing countries do not receive adequate medical treatment and an estimated percentage of 80–90% are without any treatment. Poor infrastructure, insufficient availability of drugs and scarcity of trained medical personnel are relevant factors for this situation. Traditional concepts about epilepsy may also affect acceptance and compliance to modern treatment.We report our experience with anti-epileptic drug (AED) treatment in a rural African community with a high prevalence of epilepsy. After identification of the patients during a prevalence survey on epilepsy, the input of the medical service of the district to the treatment scheme was reduced to a 6-monthly medical visit to the area and long-term provision of AED to the patients. Members of the community were integrated as assistants in the distribution of the drugs and community participation was gradually enhanced over the first year of the programme. A cost-sharing system for the financing of the community assistants was introduced and a self-help committee of epilepsy patients and their families was founded. Within the first 20 months the patients showed good compliance as indicated by a growing number of patients presenting for treatment and a low rate of discontinuation of the treatment. A marked improvement could be observed for most of the patients treated with phenobarbitone in terms of reduction of seizure frequency although complete seizure control was achieved in only a few.