| Methods |
Design: prospective cohort.
Duration: started recruitment January 2007 ‐ June 2007, followed up until November 2007, minimum 6 months follow up |
| Participants |
Country: Swaziland
Setting: rural setting, one district hospital, 30 nurse led health centres.
Inclusion criteria: adults >14 years on antiretroviral therapy for at least 4 weeks, CD4 count >100 cells/mm3.
Exclusion criteria: refused to be down referred.
Comparable CD4 count or clinical stage at baseline: CD4 count and clinical stage similar at baseline |
| Interventions |
Intervention: initiated at hospital by doctor and maintained at health centre by nurses.
Control: initiated and maintained at hospital by doctors.
Co‐interventions: training for primary care centre nurses, monthly outreach support visit by at least one counsellor and nurse |
| Outcomes |
Clinic attendance, patient experience, loss to follow up, change in CD4 count, weight, death. |
| Notes |
|
| Risk of bias |
| Bias |
Authors' judgement |
Support for judgement |
| Baseline CD4 count (All studies) |
Low risk |
Similar mean CD4 between groups. |
| Other baseline variables (All studies) |
Low risk |
Age, sex, and weight were similar at baseline, duration on antiretrovirals (longer for the control group) and and length of follow up differed by group which may favour outcomes in the control group |
| Co‐ interventions (All studies) |
Low risk |
No additional intervention described, other than monthly mobile support team visits which are part of the model of care |
| Data collection (Cohorts) |
Low risk |
Prospective cohort |
| Patient selection bias (Cohorts) |
Low risk |
Assignment was based on catchment areas (intervention clinics/control clinics) |
