Retention of adolescents living with HIV in care, treatment, and support programs in Uganda
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Date
2014
Journal Title
Journal ISSN
Volume Title
Publisher
USAID
Abstract
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.
Description
Keywords
Adolescents, HIV, Care, Treatment, Uganda
Citation
Ssali, Livingstone, Sam Kalibala, Josephine Birungi, Aggrey Egessa, Jonathan Wangisi, Joanne Lyavala Okullu, Celestin Bakanda, Stephen Okoboi, and Francis Obare. 2014. "Retention of adolescents living with HIV in care, treatment, and support programs in Uganda." Washington, DC: USAID | Project Search: HIVCore.