Browsing by Author "Egessa, Aggrey"

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    Community‑based ART distribution system can effectively facilitate long‑term program retention and low‑rates of death and virologic failure in rural Uganda
    (AIDS research and therapy, 2015) Okoboi, Stephen; Ding, Erin; Persuad, Steven; Wangisi, Jonathan; Birungi, Josephine; Shurgold, Susan; Kato, Darius; Nyonyintono, Maureen; Egessa, Aggrey; Bakanda, Celestin; Munderi, Paula; Kaleebu, Pontiano; Moore, David M.
    Community-drug distribution point is a care model for stable patients in the community designed to make ART delivery more efficient for the health system and provide appropriate support to encourage long-term retention of patients. We examined program retention among ART program participants in rural Uganda, which has used a community-based distribution model of ART delivery since 2004. Methods: We analyzed data of all patients >18 years who initiated ART in Jinja, Ugandan site of The AIDS Support Organization between January 1, 2004 and July 31, 2009. Participants attended clinic or outreach visits every 2–3 months and had CD4 cell counts measured every 6 months. Retention to care was defined as any patient with at least one visit in the 6 months before June 1, 2013. We then identified participants with at least one visit in the 6 months before June 1, 2013 and examined associations with mortality and lost-to-follow-up (LTFU). Participants with >4 years of follow up during August, 2012 to May, 2013 had viral load conducted, since no routine viral load testing was available. Results: A total of 3345 participants began ART during 2004–2009. The median time on ART in June 2013 was 5.69 years. A total of 1335 (40 %) were residents of Jinja district and 2005 (60 %) resided in outlying districts. Of these, 2322 (69 %) were retained in care, 577 (17 %) died, 161 (5 %) transferred out and 285 (9 %) were LTFU. Factors associated with mortality or LTFU included male gender, [Adjusted Hazard Ratio (AHR) = 1.56; 95 % CI 1.28–1.9], CD4 cell count <50 cells/μL (AHR = 4.09; 95 % CI 3.13–5.36) or 50–199 cells/μL (AHR = 1.86; 95 % CI 1.46–2.37); ART initiation and WHO stages 3 (AHR = 1.35; 95 % CI 1.1–1.66) or 4 (AHR = 1.74; 95 % CI 1.23–2.45). Residence outside of Jinja district was not associated with mortality/LTFU (p value = 0.562). Of 870 participants who had VL tests, 756 (87 %) had VLs <50 copies/mL. Conclusion: Community-based ART distribution systems can effectively mitigate the barriers to program retention and result in good rates of virologic suppression.
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    No differences in clinical outcomes with the addition of viral load testing to CD4 cell count monitoring among HIV infected participants receiving ART in rural Uganda: Long-term results from the Home Based AIDS Care Project
    (BMC Public Health, 2015) Okoboi, Stephen; Ekwaru, Paul John; Campbell, James D.; Egessa, Aggrey; King, Racheal; Bakanda, Celestin; Muramuzi, Emmy; Kaharuza, Frank; Malamba, Samuel; Moore, David M.
    We compared clinical outcomes among HIV-infected participants receiving ART who were randomized to viral load (VL) and CD4 cell count monitoring in comparison to CD4 cell count monitoring alone in Tororo, Uganda. Methods: Beginning in May 2003, participants with CD4 cell counts <250 cells/μL or WHO stage 3 or 4 disease were randomized to clinical monitoring alone, clinical monitoring plus quarterly CD4 cell counts (CD4-only); or clinical monitoring, quarterly CD4 cell counts and quarterly VL testing (CD4-VL). In 2007, individuals in clinical monitoring arm were re-randomized to the other two arms and all participants were followed until March 31, 2009. We used Cox Proportional Hazard models to determine if study arm was independently associated with the development of opportunistic infections (OIs) or death. Results: We randomized 1211 participants to the three original study arms and 331 surviving participants in the clinical monitoring arm were re-randomized to the CD4-VL and CD4 only arms. At enrolment the median age was 38 years and the median CD4 cell count was 134 cells/μL. Over a median of 5.2 years of follow-up, 37 deaths and 35 new OIs occurred in the VL-CD4 arm patients, 39 deaths and 42 new OIs occurred in CD4-only patients. We did not observe an association between monitoring arm and new OIs or death (AHR =1.19 for CD4-only vs. CD4-VL; 95 % CI 0.82–1.73). Conclusion: We found no differences in clinical outcomes associated with the addition of quarterly VL monitoring to quarterly CD4 cell count monitoring.
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    Retention of adolescents living with HIV in care, treatment, and support programs in Uganda
    (USAID, 2014) Ssali, Livingstone; Kalibala, Sam; Birungi, Josephine; Egessa, Aggrey; Wangisi, Jonathan
    In many countries in sub-Saharan Africa, HIV programs are organized around pediatric or adult care, with adolescents who are living with HIV being treated through pediatric care facilities. This has important implications for retention of adolescents in HIV care programs especially as they transition from pediatric to adult care. Although Uganda is considered a success story in HIV/AIDS programming, the extent to which adolescents living with HIV have been retained in care is not well understood. Retention in care is important for positive clinical outcomes such as viral load suppression and survival. The AIDS Support Organization (TASO) and the Population Council undertook a study to generate evidence on the level of and the factors associated with retention of adolescents aged 10–19 years in HIV and AIDS programs in Uganda. The study was conducted under the U.S. Agency for International Development’s (USAID) HIVCore project led by the Population Council. The study specifically examined: (1) the contextual factors that might facilitate or influence retention of adolescents in HIV care, treatment, and support services in Uganda; (2) the cascade of HIV care, treatment, and support services among adolescents aged 10–19 years in Uganda and how these patterns compare with those of adults aged 20 years and above; (3) the level of and trends in retention in care, treatment, and support programs among adolescents aged 10–19 years in the country in the context of current HIV and AIDS programs at 6, 12, 24, 36, and 48 months following initiation of antiretroviral therapy (ART); and (4) the sociodemographic characteristics that are associated with retention in HIV care, treatment, and support programs among adolescents in Uganda at three different follow-up periods (12, 24, and 36 months). The study reviewed existing national policy and program documents on HIV testing, counseling, treatment, and support as well as retrospective secondary cohort clinical data from clinics operated by TASO in Uganda. TASO implements several HIV-related activities including prevention, counseling, testing, treatment, care, and support services as well as capacity development, research, and advocacy. The study population for the clinical component comprised: (1) 22,089 adolescents aged 10–19 years and 33,139 adults aged 20 years and above who received HIV services under the home-based HIV testing and counseling (HBHTC) program from 2005 (when TASO initiated the program) to 2011; and (2) clinical records of 617 adolescent clients aged 10–19 years (at the time of enrollment) who received HIV care, treatment, and support services from TASO clinics between 2006 and 2011. The review of policy and program documents as well as the extraction and merging of clinical datasets took place from 4–15 November 2013. The HBHTC and ART datasets were obtained from 11 TASO centers. The ART datasets were extracted from the following records: Pre-ART Registry, Case Evaluation, ART Commencement, Deaths, Monitoring Refills, and Laboratory. We identified a patient cohort within the TASO Management Information System who initiated ART since 2006. Analysis involved both descriptive statistics and multivariate Cox regression analysis. Descriptive analysis entailed reviewing the cascade of HIV care, treatment, and support services under the HBHTC program as well as estimating the level of retention in TASO ART programs at 6, 12, 24, 36, and 48 months. Multivariate Cox regression analysis was conducted to determine the sociodemographic and clinical factors associated with program attrition at 12, 24, and 36 months.