Non-uptake of viral load testing among people receiving HIV treatment in Gomba district, rural Uganda.

Autor: Nakalega R; Makerere University-Johns Hopkins University (MU-JHU) Care LTD, Kampala, Uganda. rnakalega@mujhu.org., Mukiza N; Baylor College of Medicine Children's Foundation, Kampala, Uganda., Kiwanuka G; School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda., Makanga-Kakumba R; MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda., Menge R; School of Social Sciences, College of Humanities and Social Sciences, Makerere University Kampala, Kampala, Uganda., Kataike H; Makerere University-Johns Hopkins University (MU-JHU) Care LTD, Kampala, Uganda., Maena J; Makerere University-Johns Hopkins University (MU-JHU) Care LTD, Kampala, Uganda., Akello C; Makerere University-Johns Hopkins University (MU-JHU) Care LTD, Kampala, Uganda., Atuhaire P; Makerere University-Johns Hopkins University (MU-JHU) Care LTD, Kampala, Uganda., Matovu-Kiweewa F; Makerere University-Johns Hopkins University (MU-JHU) Care LTD, Kampala, Uganda., Ndikuno-Kuteesa C; School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda., Debem H; Department of Public Health and Preventive Medicine, School of Medicine, University of Liverpool, Liverpool, UK., Mujugira A; School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.; Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda.
Jazyk: angličtina
Zdroj: BMC infectious diseases [BMC Infect Dis] 2020 Oct 06; Vol. 20 (1), pp. 727. Date of Electronic Publication: 2020 Oct 06.
DOI: 10.1186/s12879-020-05461-1
Abstrakt: Background: Viral load (VL) testing is the gold-standard approach for monitoring human immunodeficiency virus (HIV) treatment success and virologic failure, but uptake is suboptimal in resource-limited and rural settings. We conducted a cross-sectional study of risk factors for non-uptake of VL testing in rural Uganda.
Methods: We conducted a cross-sectional analysis of uptake of VL testing among randomly selected people with HIV (PWH) receiving anti-retroviral treatment (ART) for at least 6 months at all eight primary health centers in Gomba district, rural Uganda. Socio-demographic and clinical data were extracted from medical records for the period January to December 2017. VL testing was routinely performed 6 months after ART initiation and 12 months thereafter for PWH stable on ART. We used descriptive statistics and multivariable logistic regression to evaluate factors associated with non-uptake of VL testing (the primary outcome).
Results: Of 414 PWH, 60% were female, and the median age was 40 years (interquartile range [IQR] 31-48). Most (62.3%) had been on ART > 2 years, and the median duration of treatment was 34 months (IQR 14-55). Thirty three percent did not receive VL testing: 36% of women and 30% of men. Shorter duration of ART (≤2 years) (adjusted odds ratio [AOR] 2.38; 95% CI:1.37-4.12; p = 0.002), younger age 16-30 years (AOR 2.74; 95% CI:1.44-5.24; p = 0.002) and 31-45 years (AOR 1.92; 95% CI 1.12-3.27; p = 0.017), and receipt of ART at Health Center IV (AOR 2.85; 95% CI: 1.78-4.56; p < 0.001) were significantly associated with non-uptake of VL testing.
Conclusions: One-in-three PWH on ART missed VL testing in rural Uganda. Strategies to improve coverage of VL testing, such as VL focal persons to flag missed tests, patient education and demand creation for VL testing are needed, particularly for recent ART initiates and younger persons on treatment, in order to attain the third Joint United Nations Program on HIV/AIDS (UNAIDS) 95-95-95 target - virologic suppression for 95% of PWH on ART.
Databáze: MEDLINE
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