Assessment of retention and virologic suppression of HIV positive clients on community pharmacy antiretroviral refill program in Kampala : retrospective cohort study

Abstract

Explanatory factors for poor retention and high viral load (VL) include; long waiting lines, congestion at the facility, poor adherence to treatment, side effects of drugs and long distance to facilities. To improve these outcomes, various strategies unique to urban setting including issuing antiretroviral (ARV) refills at private community pharmacies have been co-opted but information on the program retention and viral load suppression (VLS) at 36 months is scarce. Objective: To assess the retention and virologic suppression at 36 months among HIV positive clients enrolled on Community Pharmacy ARV Refill Program in Kampala from November 2016 to January 2017. Methods: This was retrospective cohort study that used mixed research methods to follow up 209 sampled adult stable HIV clients on the community ARV pharmacy refill program from January 2017 to January 2020. Data on variables including age, regimen type and years on ART were obtained from HMIS tools namely community pharmacy enrollment and attendance register at the community private pharmacies. The facilitators towards retention and VL suppression while on the community pharmacy ARV refill program was determined through in-depth interviews of 10 clients. The time spent on the program with focus on proportion of clients retained was measured. More to that, factors associated with VL suppression were analyzed quantitatively using modified poisson regression test at both bi-variable and multivariable level. The qualitative data was transcribed, coded and presented using quotes. Results: The estimate of clients retained on the program was 93.3%, 81.3% and 76% at 12, 24 and 36 months respectively. Of those with VL outcomes, 94% of the adult clients attending the community pharmacy ARV refill program remained virally suppressed. The likelihood of VL suppression at 36 months among adult HIV clients who were taking NNRTI based regimens was 43% lower [PR=0.57, 95% CI, 0.33 to 0.98] compared to clients on DTG based regimens. The clients through the in-depth interviews indicated that facilitators’ namely client representation, reduced waiting time and positive attitude from the health workers while seeking care at the community private pharmacies enhanced their continued uptake of ART. Conclusion: This study provides evidence of a good 12-month retention and high VL suppression at 36 months among HIV adult clients and points to the need to expand use of community private pharmacies to increase access to ART in other urban settings in Uganda.