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Studies of large HIV treatment cohorts in sub-Saharan Africa have typically shown that 60% to 70% of patients are retained in care 2 years after initiation of antiretroviral therapy (ART; Trop Med Int Health 2010; 15(suppl 1):1 and PLoS Med 2007; 4:e298). However, a much higher retention rate was recently reported for an intensive, community-based HIV treatment program in rural Rwanda.
The program was designed to address social and economic barriers to retention and included intensive pre-ART counseling, daily home visits — with directly observed therapy (DOT) — performed by trained community-health workers, a monthly transportation allowance, and, for the first 10 months, monthly food packages. The estimated cost of the program was approxim…