Assessing linkage to and retention in care among HIV patients in Uganda and identifying opportunities for health systems strengthening: a descriptive study

Boeke, Caroline E.; Nabitaka, Vennie; Rowan, Andrea; Guerra, Katherine; Kabbale, Arnold; Asire, Barbara; Magongo, Eleanor Namusoke; Nawaggi, Pamela; Mulema, Vivienne; Mirembe, Betty; Bigira, Victor; Musoke, Andrew; Katureebe, Cordelia

doi:10.1186/s12879-018-3042-8

Cited by 33 publications

(60 citation statements)

References 35 publications

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“…The scale-up of ART provision to lower-level facilities, which was earlier limited to the urban referral facilities, has made ART more accessible. There is a possibility that some patients who are recorded as lost to follow-up (LTFU), are receiving ART from other facilities or are actually dead [20,21]. Therefore, attrition of patients at facilities, may not necessarily reflect treatment cessation in HIV patients.…”

Section: Discussionmentioning

confidence: 99%

Population-based monitoring of HIV drug resistance early warning indicators in Uganda: A nationally representative survey following revised WHO recommendations

et al. 2020

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OPEN ACCESSCitation: Asio J, Watera C, Namuwenge N, Kirungi W, Musinguzi J, Mugagga K, et al. (2020) Population-based monitoring of HIV drug resistance early warning indicators in Uganda: A nationally representative survey following revised WHO recommendations. PLoS ONE 15(4): e0230451. https://doi.org/10.region (p<0.001) and Specialized ART clinics (p = 0.01) performed better in this indicator. Pharmacy stock-outs was 33.6%, with more facilities in Kampala (p<0.001), specialized ART clinics (p<0.001) and private-for-profit (p<0.001) meeting this target. Dispensing practices was met by 100% of the facilities. VLS was met by 49.2% and 50.8% of facilities met VL completion target with facilities in central region performing better (p<0.001). National prevalence for the EWIs was: on-time pill pick-up 63.3% (CI: 58.9-67.8); retention on ART at 12 months 69.9% (CI: 63.8-76.0); dispensing practices 100.0%; VLS 85.2% (CI: 81.8-88.5) and VL completion, 60.7% (CI: 56.9-64.6). ConclusionDispensing practices in all facilities were in line with the national guidelines however, there still remains a challenge to long-term ART programmatic success in monitoring patient response to treatment, and maintaining patients on ART without interruptions arising due to poor patient adherence and as a consequence of ARV supply interruption. It is therefore of high importance that the national ART program ensures intensified follow-up for patients, ensuring uninterrupted supply of ARV drugs and increasing VL monitoring at treatment centres, in order to improve patient outcomes and avert preventable HIVDR

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Section: Discussionmentioning

confidence: 99%

Population-based monitoring of HIV drug resistance early warning indicators in Uganda: A nationally representative survey following revised WHO recommendations

et al. 2020

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“…One of the primary study outcomes was linkage to care, defined as patients newly diagnosed with HIV who registered in pre-ART or ART care at the facility within 1 month of diagnosis. Adult patients who were diagnosed between December 25, 2015 and June 25, 2016 were sampled for inclusion in the pre-intervention period of the study and all pediatric patients diagnosed in that timeframe were included [ 21 ]. Due to budgetary constraints and for efficiency purposes given the large number of newly initiated patients, we did not collect data on all newly diagnosed patients but rather systematically sampled every xth patient on the testing register such that a minimum of 40 patients were sampled per facility and the smallest possible number of patients beyond that were sampled.…”

Section: Methodsmentioning

confidence: 99%

“…We set out to evaluate linkage to care among individuals testing positive for HIV and six-month retention in care in antiretrovial therapy (ART) patients before versus after rollout of the intervention. At baseline, we noted that linkage to care was quite low (approximately 50%) and that adolescents, females, and patients in more rural settings had lower linkage and retention [ 21 ]. This study provides a comprehensive assessment of a holistic but relatively low-cost intervention to improve outcomes in PLWHIV across age groups.…”

Section: Introductionmentioning

confidence: 99%

Results from a proactive follow-up intervention to improve linkage and retention among people living with HIV in Uganda: a pre-/post- study

Boeke

Nabitaka²,

Rowan³

et al. 2018

BMC Health Serv Res

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BackgroundDespite gains in HIV testing and treatment access in sub-Saharan Africa, patient attrition from care remains a problem. Evidence is needed of real-world implementation of low-cost, scalable, and sustainable solutions to reduce attrition. We hypothesized that more proactive patient follow-up and enhanced counseling by health facilities would improve patient linkage and retention.MethodsAt 20 health facilities in Central Uganda, we implemented a quality of care improvement intervention package that included training lay health workers in best practices for patient follow-up and counseling, including improved appointment recordkeeping, phone calls and home visits to lost patients, and enhanced adherence counseling strategies; and strengthening oversight of these processes. We compared patient linkage to and retention in HIV care in the 9 months before implementation of the intervention to the 9 months after implementation. Data were obtained from facility-based registers and files and analysed using multivariable logistic regression.ResultsAmong 1900 patients testing HIV-positive during the study period, there was not a statistically significant increase in linkage to care after implementing the intervention (52.9% versus 54.9%, p = 0.63). However, among 1356 patients initiating antiretroviral therapy during the follow-up period, there were statistically significant increases in patient adherence to appointment schedules (44.5% versus 55.2%, p = 0.01) after the intervention. There was a small increase in Ministry of Health-defined retention in care (71.7% versus 75.7%, p = 0.12); when data from the period of intervention ramp-up was dropped, this increase became statistically significant (71.7% versus 77.6%, p = 0.01). The increase in retention was more dramatic for patients under age 19 years (N = 84; 64.0% versus 83.9%, p = 0.01). The cost per additional patient retained in care was $47.ConclusionsImproving patient tracking and counseling practices was relatively low cost and enhanced patient retention in care, particularly for pediatric and adolescent patients. This approach should be considered for scale-up in Uganda and elsewhere. However, no impact was seen in improved patient linkage to care with this proactive follow-up intervention.Trial registrationPan African Clinical Trial Registry #PACTR201611001756166. Registered August 31, 2016.

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“…One study in Uganda found just 53% of patients linked into care (i.e. registered with a facility providing treatment) within 1 month of their HIV counselling and testing (HCT) session [ 17 ]. Using home-based testing with augmented counselling in Uganda, another study achieved 44% linkage into care [ 18 ].…”

Section: Introductionmentioning

confidence: 99%

“…Further, linkage into care may simply take time: people need to accept and adjust to the diagnosis, reconcile how to manage stigma and make practical arrangements [ 20 ]. This may be lengthened by unmet mental health needs, amongst other potential drivers including health system, community, financial, household and individual factors [ 17 , 20 , 21 ]. Mental health support may facilitate linkage by treating anxiety and depression, and addressing acceptance and stigma issues.…”

Section: Introductionmentioning

confidence: 99%

“Vital”: HIV counselling and testing staff’s views of addressing mental health with HIV in Uganda

Martin

Nalukenge

Lazarus

et al. 2020

BMC Health Serv Res

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Background Mental health is linked to HIV outcomes, including linkage into care and adherence to medication. Integrated care for mental and physical health is recommended. HIV testing and counselling sessions represent an opportunity to implement interventions to address mental health, however it is first necessary to understand the roles, current practice, knowledge and attitudes of the testing and counselling staff. Methods This qualitative study used semi-structured interviews with HIV testing and counselling staff at four centres of a HIV healthcare provider charity in Uganda. Interviews focused on their current practice, perceptions of mental health and their role in supporting this, challenges of this work, training and support needs, and views of potential greater emphasis on mental health work in their role. Data were audio-recorded, transcribed verbatim, and analysed thematically. Results Data from twenty-one testing and counselling staff revealed five themes. Clients presented to counselling staff with needs spanning bio-psycho-social domains, where psychological health was intertwined with HIV management, medication adherence, and seen as “inseparable” from HIV itself. Mental health was largely thought about as “madness”, identifiable from extreme behaviour. As such, common mental health problems of anxiety and depression were not often seen as part of mental health. Approaches to intervening with mental health were seen as behavioural, with some ideas about changing thinking styles. Participants demonstrated significant practice of common techniques to address mental health. Needs were identified for further training in suicide risk assessment and identification of depression, together with greater clinical supervision. Participants described significant conflict within their roles, particularly balancing time demands and need to achieve testing targets against the need to offer adequate mental health support to clients in need. Conclusions HIV testing and counselling staff described a diverse role that already includes addressing mental health. Mental health is “vital” to their work, however the time needed to address it is at odds with current testing targets. They require more training and resources to effectively address mental health, which is vital to optimising HIV outcomes. Interventions to integrate mental health support into HIV testing and counselling sessions need to be further researched and optimised.

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Assessing linkage to and retention in care among HIV patients in Uganda and identifying opportunities for health systems strengthening: a descriptive study

Cited by 33 publications

References 35 publications

Population-based monitoring of HIV drug resistance early warning indicators in Uganda: A nationally representative survey following revised WHO recommendations

Population-based monitoring of HIV drug resistance early warning indicators in Uganda: A nationally representative survey following revised WHO recommendations

Results from a proactive follow-up intervention to improve linkage and retention among people living with HIV in Uganda: a pre-/post- study

“Vital”: HIV counselling and testing staff’s views of addressing mental health with HIV in Uganda

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