Browsing by Author "Ssali, Livingstone"

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    Disclosure of HIV status outcome of regular counseling in a cohort of patients attending HIV clinics
    (Retrovirology, 2012) Ssali, Livingstone; Wasagami, Francis; Kateeba, Agnes; Nantume, Sophie; Kiboneka, Andrew
    The African continent bears the greatest burden of HIV/AIDS in the world. Efforts by scientists to find a vaccine for curing the pandemic have proved futile to date. The prevalence in Uganda stands at 6.4%in Adults and 0.7 % in Children, and about 1.1 million Ugandans are living with HIV/AIDS. The AIDS Support Organization started in 1987. Non disclosure of HIV sero status affects uptake of HIV/AIDS health services, increases stigma and discrimination.
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    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, Samuel
    As 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.
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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.