Researchers from the REMSTART team – led by Dr Saidi Egwaga of the Tanzanian Ministry of Health and Social Welfare and Shabbar Jaffar, Professor of Epidemiology at the London School of Hygiene & Tropical Medicine – conducted a randomised trial of 1,999 HIV patients in Tanzania and Zambia between February 2012 and September 2014.
They enrolled patients who had advanced HIV disease and were beginning treatment. Most of the deaths in African HIV programmes occur in this group at around the time or just shortly after HIV treatment is started. All patients were firstly screened for tuberculosis and started quickly on HIV treatment. Patients were then given either standard care from a clinic, or given additional care which consisted of screening for cryptococcal meningitis as well as weekly home visits for the first four weeks from lay workers to support them with antiretroviral therapy.
The trial found deaths among patients receiving the additional screening for cryptococcal meningitis and home visits were 28% lower than those receiving standard clinic care (134 deaths and 180 deaths respectively over a 12 month follow-up period).