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The impact of community health worker-led home delivery of antiretroviral therapy on virological suppression: a non-inferiority cluster-randomized health systems trial in Dar es Salaam, Tanzania

Overview of attention for article published in BMC Health Services Research, February 2017
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Title
The impact of community health worker-led home delivery of antiretroviral therapy on virological suppression: a non-inferiority cluster-randomized health systems trial in Dar es Salaam, Tanzania
Published in
BMC Health Services Research, February 2017
DOI 10.1186/s12913-017-2032-7
Pubmed ID
Authors

Pascal Geldsetzer, Joel M. Francis, Nzovu Ulenga, David Sando, Irene A. Lema, Eric Mboggo, Maria Vaikath, Happiness Koda, Sharon Lwezaula, Janice Hu, Ramadhani A. Noor, Ibironke Olofin, Elysia Larson, Wafaie Fawzi, Till Bärnighausen

Abstract

Home delivery of antiretroviral therapy (ART) by community health workers (CHWs) may improve ART retention by reducing the time burden and out-of-pocket expenditures to regularly attend an ART clinic. In addition, ART home delivery may shorten waiting times and improve quality of care for those in facility-based care by decongesting ART clinics. This trial aims to determine whether ART home delivery for patients who are clinically stable on ART combined with facility-based care for those who are not stable on ART is non-inferior to the standard of care (facility-based care for all ART patients) in achieving and maintaining virological suppression. This is a non-inferiority cluster-randomized trial set in Dar es Salaam, Tanzania. A cluster is one of 48 healthcare facilities with its surrounding catchment area. 24 clusters were randomized to ART home delivery and 24 to the standard of care. The intervention consists of home visits by CHWs to provide counseling and deliver ART to patients who are stable on ART, while the control is the standard of care (facility-based ART and CHW home visits without ART home delivery). In addition, half of the healthcare facilities in each study arm were randomized to standard counseling during home visits (covering family planning, prevention of HIV transmission, and ART adherence), and half to standard plus nutrition counseling (covering food production and dietary advice). The non-inferiority design applies to the endpoints of the ART home delivery trial; the primary endpoint is the proportion of ART patients at a healthcare facility who are virally suppressed at the end of the study period. The margin of non-inferiority for this primary endpoint was set at nine percentage points. As the number of ART patients in sub-Saharan Africa is expected to rise, this trial provides causal evidence on the effectiveness of a home-based care model that could decongest ART clinics and reduce patients' healthcare expenditures. More broadly, this trial will inform the increasing policy interest in task-shifting of chronic disease care from facility- to community-based healthcare workers. ClinicalTrials.gov: NCT02711293 . Registration date: 16 March 2016.

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The data shown below were collected from the profiles of 3 X users who shared this research output. Click here to find out more about how the information was compiled.
Mendeley readers

Mendeley readers

The data shown below were compiled from readership statistics for 221 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Unknown 221 100%

Demographic breakdown

Readers by professional status Count As %
Student > Master 47 21%
Researcher 29 13%
Student > Ph. D. Student 23 10%
Student > Doctoral Student 17 8%
Student > Bachelor 17 8%
Other 36 16%
Unknown 52 24%
Readers by discipline Count As %
Medicine and Dentistry 46 21%
Nursing and Health Professions 42 19%
Social Sciences 14 6%
Economics, Econometrics and Finance 9 4%
Agricultural and Biological Sciences 6 3%
Other 40 18%
Unknown 64 29%
Attention Score in Context

Attention Score in Context

This research output has an Altmetric Attention Score of 3. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 07 March 2017.
All research outputs
#12,911,430
of 22,958,253 outputs
Outputs from BMC Health Services Research
#4,272
of 7,688 outputs
Outputs of similar age
#150,743
of 311,177 outputs
Outputs of similar age from BMC Health Services Research
#87
of 161 outputs
Altmetric has tracked 22,958,253 research outputs across all sources so far. This one is in the 43rd percentile – i.e., 43% of other outputs scored the same or lower than it.
So far Altmetric has tracked 7,688 research outputs from this source. They typically receive more attention than average, with a mean Attention Score of 7.8. This one is in the 43rd percentile – i.e., 43% of its peers scored the same or lower than it.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 311,177 tracked outputs that were published within six weeks on either side of this one in any source. This one has gotten more attention than average, scoring higher than 51% of its contemporaries.
We're also able to compare this research output to 161 others from the same source and published within six weeks on either side of this one. This one is in the 45th percentile – i.e., 45% of its contemporaries scored the same or lower than it.