Community-based accompaniment and psychosocial health outcomes in HIV-infected adults in Rwanda: a prospective study

AIDS Behav. 2014 Feb;18(2):368-80. doi: 10.1007/s10461-013-0431-2.


We examined whether the addition of community-based accompaniment to Rwanda's national model for antiretroviral treatment (ART) was associated with greater improvements in patients' psychosocial health outcomes during the first year of therapy. We enrolled 610 HIV-infected adults with CD4 cell counts under 350 cells/μL initiating ART in one of two programs. Both programs provided ART and required patients to identify a treatment buddy per national protocols. Patients in one program additionally received nutritional and socioeconomic supplements, and daily home-visits by a community health worker ("accompagnateur") who provided social support and directly-observed ingestion of medication. The addition of community-based accompaniment was associated with an additional 44.3 % reduction in prevalence of depression, more than twice the gains in perceived physical and mental health quality of life, and increased perceived social support in the first year of treatment. Community-based accompaniment may represent an important intervention in HIV-infected populations with prevalent mental health morbidity.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anti-HIV Agents / therapeutic use*
  • CD4 Lymphocyte Count
  • Community Health Services / organization & administration
  • Community Health Workers*
  • Depression / epidemiology
  • Directly Observed Therapy
  • HIV Infections / drug therapy*
  • HIV Infections / psychology
  • Humans
  • Male
  • Medication Adherence*
  • Middle Aged
  • Prevalence
  • Prospective Studies
  • Regression Analysis
  • Residence Characteristics
  • Rural Population
  • Rwanda / epidemiology
  • Social Support*
  • Socioeconomic Factors
  • Treatment Outcome
  • Viral Load


  • Anti-HIV Agents