Rita Nakalega1, Nelson Mukiza2, Henry Debem3, George Kiwanuka2, Ronald Makanga Kakumba4, Robert Menge5, Irene-Kinera Kagimu6, Catherine Nakaye6, Juliet Allen Babirye6, Hellen Kaganzi6, Zubair Lukyamuzi6, Samuel Kizito7, Cynthia Ndikuno Kuteesa8, Andrew Mujugira2,9. 1. Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration Kampala, Kampala, Uganda. rnakalega@mujhu.org. 2. School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda. 3. Department of Public Health and Preventive Medicine, School of Medicine, University of Liverpool, Liverpool, UK. 4. MRC/UVRI & LSHTM Uganda Research Unit, Kampala, Uganda. 5. School of Social Sciences, College of Humanities and Social Sciences, Makerere University Kampala, Kampala, Uganda. 6. Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration Kampala, Kampala, Uganda. 7. Department of Global Health, School of Public Health, Boston University, Boston, USA. 8. Department of Epidemiology and Biostatistics, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda. 9. Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda.
Abstract
BACKGROUND: Antiretroviral therapy (ART) adherence is a primary determinant of sustained viral suppression, HIV transmission risk, disease progression and death. The World Health Organization recommends that adherence support interventions be provided to people on ART, but implementation is suboptimal. We evaluated linkage to intensive adherence counselling (IAC) for persons on ART with detectable viral load (VL). METHODS: Between January and December 2017, we conducted a retrospective chart review of HIV-positive persons on ART with detectable VL (> 1000 copies/ml), in Gomba district, rural Uganda. We abstracted records from eight HIV clinics; seven health center III's (facilities which provide basic preventive and curative care and are headed by clinical officers) and a health center IV (mini-hospital headed by a medical doctor). Linkage to IAC was defined as provision of IAC to ART clients with detectable VL within three months of receipt of results at the health facility. Descriptive statistics and multivariable logistic regression analyses were used to evaluate factors associated with linkage to IAC. RESULTS: Of 4,100 HIV-positive persons on ART for at least 6 months, 411 (10%) had detectable VL. The median age was 32 years (interquartile range [IQR] 13-43) and 52% were female. The median duration on ART was 3.2 years (IQR 1.8-4.8). A total of 311 ART clients (81%) were linked to IAC. Receipt of ART at a Health Center level IV was associated with a two-fold higher odds of IAC linkage compared with Health Center level III (adjusted odds ratio [aOR] 1.78; 95% CI 1.00-3.16; p = 0.01). Age, gender, marital status and ART duration were not related to IAC linkage. CONCLUSIONS: Linkage to IAC was high among persons with detectable VL in rural Uganda, with greater odds of linkage at a higher-level health facility. Strategies to optimize IAC linkage at lower-level health facilities for persons with suboptimal ART adherence are needed.
BACKGROUND: Antiretroviral therapy (ART) adherence is a primary determinant of sustained viral suppression, HIV transmission risk, disease progression and death. The World Health Organization recommends that adherence support interventions be provided to people on ART, but implementation is suboptimal. We evaluated linkage to intensive adherence counselling (IAC) for persons on ART with detectable viral load (VL). METHODS: Between January and December 2017, we conducted a retrospective chart review of HIV-positive persons on ART with detectable VL (> 1000 copies/ml), in Gomba district, rural Uganda. We abstracted records from eight HIV clinics; seven health center III's (facilities which provide basic preventive and curative care and are headed by clinical officers) and a health center IV (mini-hospital headed by a medical doctor). Linkage to IAC was defined as provision of IAC to ART clients with detectable VL within three months of receipt of results at the health facility. Descriptive statistics and multivariable logistic regression analyses were used to evaluate factors associated with linkage to IAC. RESULTS: Of 4,100 HIV-positive persons on ART for at least 6 months, 411 (10%) had detectable VL. The median age was 32 years (interquartile range [IQR] 13-43) and 52% were female. The median duration on ART was 3.2 years (IQR 1.8-4.8). A total of 311 ART clients (81%) were linked to IAC. Receipt of ART at a Health Center level IV was associated with a two-fold higher odds of IAC linkage compared with Health Center level III (adjusted odds ratio [aOR] 1.78; 95% CI 1.00-3.16; p = 0.01). Age, gender, marital status and ART duration were not related to IAC linkage. CONCLUSIONS: Linkage to IAC was high among persons with detectable VL in rural Uganda, with greater odds of linkage at a higher-level health facility. Strategies to optimize IAC linkage at lower-level health facilities for persons with suboptimal ART adherence are needed.
Authors: Geoffrey Ndikabona; John Bosco Alege; Nicholas Sebuliba Kirirabwa; Derrick Kimuli Journal: BMC Public Health Date: 2021-12-18 Impact factor: 3.295