Community‑based ART distribution system can effectively facilitate long‑term program retention and low‑rates of death and virologic failure in rural Uganda
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Date
2015
Journal Title
Journal ISSN
Volume Title
Publisher
AIDS research and therapy
Abstract
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.
Description
Keywords
Antiretroviral therapy, Virologic failure, Lost-to-follow-up; mortality, Retention, Sub-Saharan Africa, Uganda
Citation
Okoboi, S., Ding, E., Persuad, S., Wangisi, J., Birungi, J., Shurgold, S., ... & Moore, D. M. (2015). 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, 12(1), 1-9. DOI 10.1186/s12981-015-0077-4