Retention in care among people living with HIV initiated on ART the same day of HIV diagnosis in Mpigi District

Abstract

Introduction: Retention in HIV care following same-day ART initiation is a critical element that is closely associated with optimal individual and public health outcomes. The People Living with HIV who are retained tend to have better survival, improved health, and achieve viral load suppression. The study determined the prevalence of retention and its predictors at 24 months following same-day ART initiation at public facilities.

Methods: This was a retrospective cohort design involving analysis of program data in the period January to June 2020 and final outcome determined by June 2022 at public facilities. The quantitative data determined the proportion of PLHIV retained in care and associated predictors. Qualitative explored enablers and reasons for non-retention. The quantitative data was extracted from EMR, ART cards, HTS, and ART registers. Key Informants Interviews with clinicians and nurses in ART clinics and FGDs with PLHIV on ART were conducted. Quantitative data was analyzed using Stata version 17.0, descriptive statistics, bivariate and multivariate modified Poisson regression analysis was done. Qualitative data analysis involved coding and thematic content analysis.

Results: A sample of 416 People Living with HIV was extracted from ART registers and EMR, and 405 People Living with HIV were included in the final analysis. The median age was 29(23-38) years with interquartile range Q1-Q3. Females were 64.4% and males 35.6%. Most of the participants (70.9%) were married, never married (17.5%) and 9.9% had divorced or separated. The majority were in clinical stage I (86.4), and Stage II (10.4%) while Stage III and IV were 3%. Those with CD4 cell count greater than 200 Cells were 80.6%, less than 200 cell count (19.4%) while Normal BMI (57.5%), pre-obese (19.3%), underweight(17.3%%) and obese (5.9%). The prevalence of retention was 46.2% (187). PLHIV with less than 3-month refills and a history of missing appointments were less likely to be retained in HIV care aPR 0.63 (0.51-0.79)) and aPR 0.72 (0.63-0.83) respectively. There was no significant difference in retention by age and sex. Peer and social network support, disclosure, use of counsellors, longer ARV refills, Community ART refills, privacy, confidentiality, telephone reminders, and home visits were facilitators of retention in HIV care while stigma, discrimination, ARV shortages, faith, traditional beliefs and suboptimal relationship with health workers hindered retention in HIV care among PLHIV.

Conclusion: Retention in HIV care following same-day ART initiation is low. However, multi-month dispensing and peer support play a pivotal role in improving retention following same-day ART initiation. The Ministry of health needs to enhance the peer support system in HIV clinics through capacity-building efforts and training on minimum HIV packages.