Navigating the HIV pathway among HIV-positive men at Kawaala health center III, Kampala, Uganda: a retrospective cohort study.

Abstract

Introduction: Although Uganda has made significant success in scaling up ART initiation among people living with HIV, the majority of men living with HIV remain undiagnosed. Even among those men who are diagnosed, up to 48% do not access HIV care and treatment on time. Worse still, a big number of those enrolled in HIV care get lost to follow-up at every step along the HIV pathway. This study aimed at describing the navigation pattern of HIV positive men along the HIV pathway in urban public health facilities of Kampala City Council Authority, in order to develop specific interventions that enhance HIV positive men’s retention at the various phases along the HIV pathway. Methods: A retrospective cohort study was conducted for the period of October 2016 to September 2017, file records of 281 men who were tested and diagnosed as HIV positive from the month of October 2016 – to the month of September 2017 were retrieved and reviewed to determine the proportions of men who had been linked to HIV care. All men who had been linked to HIV care were followed up for a duration of twelve months to determine those who had been retained in HIV care. In-depth interviews were conducted with 45 men who had gone through the various phases of the HIV pathway during the study period to explore the motivators for retention and facilitators to disengagement along the HIV pathway. Key informant interviews were conducted with 15 health workers from Kawaala H/C III who provided routine HIV care and management to determine interventions that can be put in place to strengthen the retention of men along the HIV pathway. Statistical chi square models and deductive thematic content analyses were used to determine and describe the variables associated with men’s retention along HIV pathway. Results: The mean age of the men was 33 years (SD= 10). Seventy-one percent of the men resided in Kampala district and 43% were married. 80% of the men were Christians. xiii Of the 281 HIV positive men whose records were retrieved, 242 (86%) were linked to Pre-ART services (39 clients disengaged after testing HIV positive). Out of the 242 who were linked for Pre-ART services, 37.4% (105) were enrolled on ART (137 disengaged before ART initiation). Out of the 105 men who were initiated on ART, 24.5% (69) remained engaged in the HIV pathway by the end of the twelve months’ study period (36 disengaged after ART initiation). Of those who disengaged from care (n=212), Up to 75.4% (212), 18.4% (39) disengaged immediately after testing HIV positive, 65 % (137) disengaged during Pre-ART phase and 17% (36) disengaged after ART initiation phase. Outcomes of the men who had disengaged showed that 42% (90) had promised to return to care, 22% (46) were lost to follow up, 14% (30) men had self-transferred to other facilities offering HIV services, 10% (21) men refused to resume care and 12% (25) had died. Findings from the qualitative component indicated that retention along the HIV pathway was largely influenced by affordability of transport, feeling healthy despite the positive HIV status, good social support system and healthy worker professionalism. Conclusion: At the end of the 12 months’ study period, only 24.5% (69) of the men were still retained in HIV pathway. A total of 212 (74%) HIV positive men had fallen off the HIV pathway. This shows a very high rate of disengagement of men from the HIV pathway.