Browsing by Author "Kalibala, Samuel"
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Item Factors associated with long-term antiretroviral therapy attrition among adolescents in rural Uganda: a retrospective study(Journal of the International AIDS Society, 2016) Okoboi, Stephen; Ssali, Livingstone; Yansaneh, Aisha I.; Bakanda, Celestin; Birungi, Josephine; Nantume, Sophie; Lyavala Okullu, Joanne; Sharp, Alana R.; Moore, David M.; Kalibala, SamuelAs access to antiretroviral therapy (ART) increases, the success of treatment programmes depends on ensuring high patient retention in HIV care. We examined retention and attrition among adolescents in ART programmes across clinics operated by The AIDS Support Organization (TASO) in Uganda, which has operated both facility- and community-based distribution models of ART delivery since 2004. Methods: Using a retrospective cohort analysis of patient-level clinical data, we examined attrition and retention in HIV care and factors associated with attrition among HIV-positive adolescents aged 10 19 years who initiated ART at 10 TASO clinics between January 2006 and December 2011. Retention in care was defined as the proportion of adolescents who had had at least one facility visit within the six months prior to 1 June 2013, and attrition was defined as the proportion of adolescents who died, were lost to follow-up, or stopped treatment. Descriptive statistics and Cox proportional hazards regression models were used to determine the levels of retention in HIV care and the factors associated with attrition following ART initiation. Results: A total of 1228 adolescents began ART between 2006 and 2011, of whom 57% were female. The median duration in HIV care was four years (IQR 3 6 years). A total of 792 (65%) adolescents were retained in care over the five-year period; 36 (3%) had died or transferred out and 400 (32%) were classified as loss to follow-up. Factors associated with attrition included being older (adjusted hazard ratio (AHR) 1.38, 95% confidence interval (CI) 1.02 1.86), having a higher CD4 count (250 cells/mm3) at treatment initiation (AHR 0.49, 95% CI 0.34 0.69) and HIV care site with a higher risk of attrition among adolescents in Gulu (AHR 2.26; 95% CI 1.27 4.02) and Masindi (AHR 3.30, 95% CI 1.87 5.84) and a lower risk of attrition in Jinja (AHR 0.24, 95% CI 0.08 0.70). Having an advanced WHO clinical stage at initiation was not associated with attrition. Conclusions: We found an overall retention rate of 65%, which is comparable to rates achieved by TASO’s adult patients and adolescents in other studies in Africa. Variations in the risk of attrition by TASO treatment site and by clinical and demographic characteristics suggest the need for early diagnosis of HIV infection, use of innovative approaches to reach and retain adolescents living with HIV in treatment and identifying specific groups, such as older adolescents, that are at high risk of dropping out of treatment for targeted care and support.Item Meaningful involvement of people living with HIV/AIDS in Uganda through linkages between network groups and health facilities: An evaluation study(Psychology, health & medicine, 2012) Kim, Young Mi; Kalibala, Samuel; Neema, Stella; Lukwago, John; Weiss, Deborah C.While community-based groups are able to provide vital support to people living with HIV/AIDS (PLHIV), their organizational and technical capacities are limited, and they frequently operate in isolation from PLHIV groups. We evaluated a threeyear project implemented by the International HIV/AIDS Alliance in Uganda to increase the involvement of PLHIV in the HIV/AIDS response and to improve access to and utilization of prevention, treatment, care, and support services for households affected by HIV/AIDS. Information sources included project monitoring data, interviews with 113 key informants, and 17 focus group discussions in 11 districts. The evaluation found that PLHIV groups reached large numbers of people with education and awareness activities and made a growing number of referrals to health facilities and community-based services. The project trained individuals living openly with HIV as service providers in the community and at designated health facilities. Their presence helped to reduce the stigma that previously deterred PLHIV from seeking care and encouraged individuals to disclose their HIV status to spouses and family members. The project has put into practice the widely endorsed principles of greater and meaningful involvement of PLHIV in a systematic manner and on a large scale. A wide audience – ranging from grassroots PLHIV networks and AIDS service organizations to national-level non-governmental organizations, government agencies, and international organizations – can benefit from the lessons learned.