‘Test and Treat’ Among Women at High Risk for HIV-infection in Kampala, Uganda: Antiretroviral Therapy Initiation and Associated Factors

Abstract

Data on implementation of ‘Test and Treat’ among key populations in sub-Saharan Africa are still limited. We examined factors associated with prompt antiretroviral therapy/ART (within 1 month of HIV-positive diagnosis or 1 week if pregnant) among 343 women at high risk for HIV infection in Kampala-Uganda, of whom 28% initiated prompt ART. Most (95%) reported paid sex within 3 months prior to enrolment. Multivariable logistic regression was used to determine baseline characteristics associated with prompt ART. Sex work as main job, younger age and being widowed/separated were associated with lower odds of prompt ART; being enrolled after 12 months of implementing the intervention was associated with higher odds of prompt ART. Younger women, widowed/separated and those reporting sex work as their main job need targeted interventions to start ART promptly after testing. Staff supervision and mentoring may need strengthening during the first year of implementing ‘test and treat’ interventions.

Understanding the Time Needed to Link to Care and Start ART in Seven HPTN 071 (PopART) Study Communities in Zambia and South Africa

“…Our analysis identified some groups (for example, younger men and mobile populations) as often being slower to start ART, probably because the health service delivery mechanisms are not appropriate to their needs. These observations are in keeping with the findings from other studies [ 12 , 16 , 22 , 28 , 58 ]. As has been demonstrated recently with the findings for the ANRS 12249 TasP Cluster-Randomised Trial, even in the controlled environment of a trial, ensuring prompt treatment may be challenging [ 15 ].…”

Treatment outcome of the implementation of HIV test and treat policy at The AIDs Support Organization (TASO) Tororo clinic, Eastern Uganda: A retrospective cohort study

“…In this study, we found a high uptake of HIV test and treat program where 92.4% of all individuals who were tested HIV positive accepted ART initiation within one month of HIV diagnosis. This therefore demonstrates a significant progress in the uptake of test and treat program in Uganda particularly and Africa at large, from 28% among women at risk of HIV infection in Kampala [7], 49.1%among children in Uganda [6], and 65% in Zimbabwe [8]. This high uptake of test and treat could have resulted from increased sensitization of the community on the benefits of early ART initiation for clients who are HIV positive, and if sustained will lead to attainment of the UNAIDS2030 target of 95-95-95.…”

“…Socio-demographic characteristics such as younger age and being widowed/separated were earlier identified in Uganda [7] as being associated with low chances of prompt ART initiation. This was however not the case in our study as both age and marital status did not have any significant association with failure to enroll clients under the test and treat policy.…”

“…4% and 8.6% respectively in the later initiators [6]. Whereas 28% of 343 women at high risk for HIV infection in Kampala-Uganda initiated ART promptly, with sex work as main job, younger age and being widowed/ separated found to be associated with lower odds of prompt ART [7]. Studies on test and treat programmatic outcome in Zimbabwe found same day initiation on ART among 972 newly identified positives to be 65% and 90% of patients initiated on ART were retained in care at 3 months [8].…”

“…One study which compared treatment outcomes among children initiated on treatment promptly (within 1 week of HIV diagnosis) and those that delayed treatment; found shorter time to viral suppression among prompt ART initiators than those who delayed (24.9months vs 38.5months) [6]. Another study assessed the factors associated with prompt ART initiation among women with high risk of HIV infection in Kampala and found low uptake (28%) of test and treat intervention [7]. No similar studies have been conducted in Tororo district and this study addressed the gap.…”