Extending HIV Care Beyond the Rural Health Center

• Death
• viral load
• Hospitalized
• New opportunistic infect
• Antiretroviral regimen failure
• Loss to follow-up

• Viral load [ Time Frame: 12 months ] [ Designated as safety issue: Yes ]
• Hospitalization [ Time Frame: 6 and 12 months ] [ Designated as safety issue: Yes ]
• New Opportunistic Infection [ Time Frame: 6 and 12 months ] [ Designated as safety issue: Yes ]
• Antiretroviral Regimen failure [ Time Frame: 6 and 12 months ] [ Designated as safety issue: Yes ]
• Lost to follow-up [ Time Frame: 12 months ] [ Designated as safety issue: Yes ]
• Death [ Time Frame: 12 months ] [ Designated as safety issue: Yes ]

The objective of this application is to develop and assess a system which uses non-clinician extenders to provide selected aspects of HIV care in rural western Kenya. The plan is to train persons living with HIV/AIDS (PLWAs) to undertake this role as Community Care Coordinators. Our central hypothesis, is that PLWAs can be effective members of the health care team and that their involvement in community-based HIV care will facilitate patient access to services and improve outcomes. As such our two specific aims are: 1) To develop a sustainable system to extend HIV care into the community and to train the individuals necessary to support such a system (Community Care Coordinators). 2) To determine the impact of Community Care Coordinators on patient adherence (to drugs and to clinic visits), clinical outcomes (i.e. viral load responses [an individuals level of circulating HIV virus], inter-current opportunistic infections, hospitalization, drop out from the program, change to second line therapy and mortality) and patient perception of stigma. This study will provide invaluable data on the use of non-clinician care extenders for providing HIV care in resource poor settings. As such, knowledge gained from this study will assist in developing a model for non-clinician centered HIV care systems elsewhere in sub-Saharan Africa.

• HIV
• HIV Infections

• Behavioral: Control Group
  Routine care in the clinic on a monthly basis
• Other: Home visit by community care coordinators
  Decrease in patient visits to the clinic from the standard of once per month to every 3 months with home visits monthly.

• No Intervention: I
  Routine care in the clinic
  Intervention: Behavioral: Control Group
• Experimental: II
  Follow-up in clinic every 3 months, home visits monthly
  Intervention: Other: Home visit by community care coordinators

Inclusion Criteria:

1. HIV infected
2. >18 years old
3. household members are aware of the patient's HIV infection
4. clinically stable on ARVs and no significant adherence issues for 3 months, 5) live in Kosirai Division

6) willing to consent to participate.

Exclusion Criteria:

1. active opportunistic infection
2. pregnant
3. hospitalized in the previous 3 months
4. unable to understand the informed consent process due to mental or physical incapacity.