Impact of an intensive facility-community case management intervention on 6-month HIV outcomes among select key and priority populations in Uganda

• Published in: AIDS research and therapy 2022-12, Vol.19 (1), p.62-62, Article 62
• Main Authors: Meya, David B, Kiragga, Agnes N, Nalintya, Elizabeth, Banturaki, Grace, Akullo, Joan, Kalyesubula, Phillip, Sessazi, Patrick, Bitakalamire, Hillary, Kabanda, Joseph, Kalamya, Julius N, Namale, Alice, Bateganya, Moses, Kagaayi, Joseph, Gutreuter, Steve, Adler, Michelle R, Mitruka, Kiren
• Format: Article
• Language: English
• Subjects: Adult; Anti-HIV Agents - therapeutic use; Antiretroviral agents; Antiretroviral therapy; Antiviral agents; Case Management; Community involvement; Diagnosis; Diaries; Disease prevention; Disease transmission; Distribution; Dosage and administration; Drug therapy; Evaluation; Female; Females; Fish populations; Gender; Health care facilities; Health Facilities; Health risks; HIV; HIV infection; HIV Infections - drug therapy; HIV Infections - epidemiology; Human immunodeficiency virus; Humans; Infections; Intervention; Key populations; Male; Patient outcomes; Phases; Populations; Regression analysis; Regression models; Retention; Retention in care; Risk taking; Sex industry; Sex Workers; Sexually transmitted diseases; Statistical analysis; STD; Uganda - epidemiology; Viral suppression
• ISSN: 1742-6405; 1742-6405
• DOI: 10.1186/s12981-022-00486-9

Key and priority populations (with risk behaviours and health inequities) are disproportionately affected by HIV in Uganda. We evaluated the impact of an intensive case management intervention on HIV treatment outcomes in Kalangala District, predominantly inhabited by fisher folk and female sex workers. This quasi-experimental pre-post intervention evaluation included antiretroviral therapy naïve adults aged ≥ 18 years from six health facilities in the pre-intervention (Jan 1, 2017-December 31, 2017) and intervention phase (June 13, 2018-June 30, 2019). The primary outcomes were 6-month retention and viral suppression (VS) before and after implementation of the intervention involving facility and community case managers who supported participants through at least the first three months of ART. We used descriptive statistics to compared the characteristics, overall outcomes (i.e., retention, lost to follow up, died), and VS of participants by phase, and used mixed-effects logistic regression models to determine factors associated with 6-month retention in care. Marginal (averaging over facilities) probabilities of retention were computed from the final multivariable model. We enrolled 606 and 405 participants in the pre-intervention and intervention phases respectively. Approximately 75% of participants were aged 25-44 years, with similar age and gender distributions among phases. Approximately 46% of participants in the intervention were fisher folk and 9% were female sex workers. The adjusted probability of 6-month retention was higher in the intervention phase, 0.83 (95% CI: 0.77-0.90) versus pre-intervention phase, 0.73 (95% CI: 0.69-0.77, p = 0.03). The retention probability increased from 0.59 (0.49-0.68) to 0.73 (0.59-0.86), p = 0.03 among participants aged 18-24 years, and from 0.75 (0.71-0.78) to 0.85 (0.78-0.91), p = 0.03 among participants aged ≥ 25 years. VS (