Prevalence and factors associated with advanced HIV disease at enrolment in care among adults aged  18 years at selected Public Health Centres in Kampala city, Uganda.

Abstract

Background: Despite successes in HIV/AIDS care in Uganda, a high number of people are still dying from AIDS related illnesses. Advanced HIV disease (AHD) at enrolment in care is still a problem four years after the adoption of WHO’s Treat All policy. This study was conducted to determine the prevalence of AHD at enrolment in care and associated factors at selected public health centres in Kampala during the Treat All era. Methods: A cross-sectional study employing both quantitative and qualitative data collection methods was conducted at three public health centres in Kampala city. Quantitative data was collected using standardized interviewer administered questionnaires and modified Poisson regression used to identify factors associated with AHD at enrolment in care. In depth interviews were used to collect qualitative data and analysed using thematic analysis. Findings: Overall, 35.1% (95% CI: 31.3 – 39.0) of study participants had advanced HIV disease at enrolment in care. This was associated with being male (Adjusted PR: 1.38, 95% CI: 1.11 – 1.735) and age 35 years and above (Adjusted PR: 1.75, 95% CI: 1.19 – 2.59). The prevalence of advanced HIV disease was lower among those who did not report any personal health perception barriers compared to those who did (Adjusted PR: 0.63, 95% CI:0.49 – 0.82). Qualitative findings revealed that individual factors took precedence in contributing to enrolling in care with advanced HIV disease. These included feeling healthy, waiting till physical health deteriorated and first opting for alternative therapies. Other factors were fear of HIV diagnosis and HIV medication. Conclusion: The study findings show that advanced HIV disease at enrolment in care was high during the Treat All era with the prevalence being higher among males and adults aged ≥35 years. Qualitative findings further revealed that personal health perception barriers contribute to enrolling in care with advanced HIV disease, with most individuals perceiving themselves to be still healthy. Recommendations: There is urgent need for implementing partners and health workers to innovate testing strategies targeting men and older people. Such efforts should include interventions to improve the quality and modification of HIV testing health education messages emphasizing routine testing regardless of one’s perception of their health status. The Ministry of Health should also revise the national HIV Testing Services (HTS) policy and implementation guidelines should to include incentives for early and routine HIV testing apart from provision of free HIV testing services