Factors associated with timely linkage to HIV care among adult HIV patients in private not for profit health facilities in Kampala, Uganda.
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Background: There has been an increase in the availability of anti-retroviral therapy (ART) for human immunodeficiency virus (HIV) patients but timely linkage to care is still low in Uganda. Studies have documented timely linkage to care in public health facilities, but little is known about timely linkage to care in private not for profit (PNFP) health facilities. Understanding of timely linkage to HIV care in PNFP health facilities is important in improving linkage to HIV care since many people seek for health care services including HIV Counselling and Testing (HCT) in these facilities. The purpose of the study was to assess the factors associated with timely linkage to HIV care in PNFP health facilities in Kampala. Methods: A cross-sectional study was carried out among 430 adult HIV patients who were enrolled in HIV care in two PNFP health facilities in Kampala for quantitative component and eight key informants for the qualitative part. Quantitatively, interviewer administered questionnaires were used to collect data. A key informant guide was used to collect qualitative data. Quantitative data were analysed using STATA version 14. Modified Poisson regression analysis, with robust standard errors was used to determine association between timely linkage to care and independent variables at 95% CI. Qualitative data were analysed using the conventional content analysis approach. Results: Majority of the participants had informal employment 344/430 (80.0%), were females 243/430 (56.5%) and had a mean age of 34.2 years (SD=8.7). Majority 365/430 (84.9%) of participants were enrolled into HIV care within 30 days. Individual factors associated with timely linkage to HIV care included male sex (APR 0.83; 95% CI 0.77 - 0.90), age 27-34 years (APR 1.23; 95% CI 1.05 - 1.44) and 35-44 years (APR 1.19; 95% CI 1.01 - 1.40), completed secondary education (APR 1.21; 95% CI 1.02 - 1.43), unemployed (APR 1.18; 95% CI 1.07 - 1.31), disclosure of HIV status (APR 1.34; 95% CI 1.19 - 1.52), seeking for divine/spernatural healing from religious before enrolling into HIV care (APR 0.83; 95% CI 0.71 - 0.97), having TB at the time of enrolment into HIV care (APR 1.30; 95% CI 1.13 - 1.49), CD4 of 201 - 350 cells/mm3 (APR 1.19, 95% 1.04 - 1.37) and CD4 >350 cells/mm3 at the time of enrolment into HIV care (APR 1.20, 95% CI 1.05 - 1.37). Health system factors included participants being told how long they should take to enrol into care (APR 1.23; 95% CI 1.02 - 1.48), health workers discussing with participants where they should register for HIV care (APR 2.12; 95% CI 1.36 - 3.31), participants feeling they received all necessary information about HIV status at the time of HIV diagnosis (APR 3.13; 95% CI 1. 65 - 5.94) and deciding to receive treatment from the health facility because of privacy at health facility (APR 0.88; 95% CI 0.79 - 0.94). Qualitative findings showed that facilitators of timely linkage to HIV care included availability of HIV testing and counselling) HCT services, good quality of services, positive implications of the test and treat policy and availability of ART and the barriers included information gap among health workers, lack of motivation among the health providers and inadequate drugs and supplies. Conclusion: Timely linkage to HIV care was high among HIV patients who were registered in HIV care. This was attributed to disclosure of HIV status, providing all necessary information about HIV status, discussing with HIV patients how long they should take to enrol into HIV care and where to enrol from. Encouraging health care workers to always tell the HIV patients how long they should take to enrol into HIV care and where to register for care from and involving religious leaders in HIV prevention and control programs will improve timely linkage to HIV care.