Impact of an intensive facility-community case management intervention on 6-month HIV outcomes among select key and priority populations in Uganda

AIDS Research and Therapy

Research

Agnes N. Kiragga¹  Elizabeth Nalintya¹  Joan Akullo¹  Phillip Kalyesubula¹  Grace Banturaki¹  Patrick Sessazi¹  David B. Meya²  Hillary Bitakalamire³  Joseph Kagaayi⁴  Moses Bateganya⁵  Steve Gutreuter⁵  Kiren Mitruka⁵  Alice Namale⁶  Joseph Kabanda⁶  Julius N. Kalamya⁶  Michelle R. Adler⁶ 

[1] Infectious Diseases Institute, College of Health Sciences, Makerere University, Mulago Hill Road, 22418, Kampala, Uganda;Infectious Diseases Institute, College of Health Sciences, Makerere University, Mulago Hill Road, 22418, Kampala, Uganda;Department of Medicine and International Health, University of Minnesota, Minneapolis, MN, USA;School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda;Kalangala District Health Services, Kalangala, Uganda;Rakai Health Sciences, Program, Rakai, Uganda;Makerere School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda;U.S Centers for Disease Control and Prevention, Atlanta, GA, USA;U.S Centers for Disease Control and Prevention, Kampala, Uganda;

关键词: Antiretroviral therapy;    Retention in care;    Key populations;    Viral suppression;    HIV;   

DOI  :  10.1186/s12981-022-00486-9

 received in 2022-05-08, accepted in 2022-11-14,  发布年份 2022

来源: Springer

【 摘 要 】

IntroductionKey and priority populations (with risk behaviours and health inequities) are disproportionately affected by HIV in Uganda. We evaluated the impact of an intensive case management intervention on HIV treatment outcomes in Kalangala District, predominantly inhabited by fisher folk and female sex workers.MethodsThis quasi-experimental pre-post intervention evaluation included antiretroviral therapy naïve adults aged ≥ 18 years from six health facilities in the pre-intervention (Jan 1, 2017–December 31, 2017) and intervention phase (June 13, 2018–June 30, 2019). The primary outcomes were 6-month retention and viral suppression (VS) before and after implementation of the intervention involving facility and community case managers who supported participants through at least the first three months of ART. We used descriptive statistics to compared the characteristics, overall outcomes (i.e., retention, lost to follow up, died), and VS of participants by phase, and used mixed-effects logistic regression models to determine factors associated with 6-month retention in care. Marginal (averaging over facilities) probabilities of retention were computed from the final multivariable model.ResultsWe enrolled 606 and 405 participants in the pre-intervention and intervention phases respectively. Approximately 75% of participants were aged 25–44 years, with similar age and gender distributions among phases. Approximately 46% of participants in the intervention were fisher folk and 9% were female sex workers. The adjusted probability of 6-month retention was higher in the intervention phase, 0.83 (95% CI: 0.77–0.90) versus pre-intervention phase, 0.73 (95% CI: 0.69–0.77, p = 0.03). The retention probability increased from 0.59 (0.49–0.68) to 0.73 (0.59–0.86), p = 0.03 among participants aged 18–24 years, and from 0.75 (0.71–0.78) to 0.85 (0.78–0.91), p = 0.03 among participants aged ≥ 25 years. VS (< 1,000 copies/mL) was approximately 87% in both phases.ConclusionsAfter implementation of the case management intervention, we observed significant improvement in 6-month retention in all age groups of a highly mobile population of predominantly fisher folk.

【 授权许可】

CC BY   
© The Author(s) 2022