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Mortality in HIV-infected Ugandan adults receiving antiretroviral treatment and survival of their HIV-uninfected children: a prospective cohort study

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Abstract with commentary from UCSF Institute for Global Health. Mermin and coauthors provide an important contribution to managing health care in resource poor settings in their recent report on utilizing home-based care for delivery of antiretroviral therapy. One approach used by the Ugandan government to deliver improved health care is to provide incremental increases in the delivery of specific therapies. Previous studies showed that initial use of insecticide treated bed nets and prophylactic cotrimoxazole significantly reduced mortality in HIV-infected adults. (Colindres et al, 2008) The current article reports, that in a cohort of 466 HIV-infected adults and 1481 HIV uninfected household members, the introduction of ART in a home-based care setting was both feasible and effective in reduced mortality relative to rates seen with bed nets and cotrimoxazole only. These encouraging results suggest that there may be additional opportunities for expanding the use of home-based care settings beyond providing ART such as treatment for tuberculosis or nutritional supplementation, reducing the strain on overburdened clinics and hospitals that are experiencing health care worker shortages. For further reading on the subject, see Chen et al., 2004.