The use of antiretroviral treatment (ART) in a home-based setting could dramatically reduce AIDS deaths in developing nations, particularly those in sub-Saharan Africa, a new study shows.

To assess the feasibility of home-based ART, CDC's Jonathan Mermin in Nairobi and colleagues conducted a phased, five-year study of HIV patients and their families in rural Uganda.

In 2001, basic counseling, diarrhea prevention, and hygiene education were provided to 466 HIV-infected adults and 1,481 households without any infected members over a five-month period. In a second phase, a daily dose of antibiotics was administered to HIV patients to prevent opportunistic infections.

In the third phase, from 2003 to 2005, 138 HIV-infected adults from the original group and 907 new participants with HIV and their households were enrolled in an ART study that included lamivudine, stavudine, and nevirapine. Households received weekly visits from non-professional providers, and no clinic visits were scheduled.

In the first 16 weeks of combined ART and antibiotic treatment, mortality among HIV-infected participants was 55 percent less than with antibiotic treatment alone. Compared with no intervention, combination treatment resulted in a 95 percent mortality reduction.

"These results were achieved even though no routine clinic visits were scheduled after initial enrollment, and home visits were provided by trained lay providers," the researchers said. "Our findings support the efforts to bring ART to people with HIV throughout the world, irrespective of geographic or socioeconomic background," they concluded.

The study, "Mortality in HIV-Infected Ugandan Adults Receiving Antiretroviral Treatment and Survival of Their HIV-Uninfected Children: A Prospective Cohort Study," was published in The Lancet (2008;371(9614):752-759).

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