Effect and implementation experience of intensive adherence counseling in a public HIV care center in Uganda: a mixed‑methods study
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Date
2021
Journal Title
Journal ISSN
Volume Title
Publisher
BMC infectious diseases
Abstract
Intensive adherence counseling (IAC) is an intervention recommended by the World Health Organization
to improve anti-retroviral therapy (ART) adherence among people living with HIV on ART with unsuppressed viral
load; and in 2016, the intervention was implemented in Uganda. This study evaluated the effect and experiences of
providing IAC in an urban HIV care center in Kampala, Uganda.
Methods: This was a sequential explanatory mixed-method study that compared viral load suppression during
IAC implementation (intervention) to the period before IAC at Kisenyi Health centre IV. Data were abstracted from
patient files and viral load register. The effect of IAC on viral load suppression and associated factors were analyzed
using modified Poisson regression with robust standard errors. Using in-depth interviews and an inductive analysis
approach in Atlas-ti 8. We also explored experiences of providing IAC among healthcare workers.
Results: A total of 500 records were sampled: 249 (49.8%) in the intervention period and 251 (51.2%) in the preintervention
period. The mean age was lower during the intervention period 33.1 (± 12.0) than 36.5 (± 13.4) in the
pre- intervention period, p = 0.002. More clients were currently on Protease-based regimen in the pre-intervention
period 179 (71.3%) than 135 (54.2%) in the intervention period, p ≤ 0.001. In the intervention period, all eligible clients
received IAC [249/249 (100.0%)]. Overall, 325 (65.0%) received IAC and of these, 143 (44.1%) achieved viral load suppression
compared to 46 (26.3%) who received regular counseling. Receiving IAC significantly increased viral load
suppression by 22% (aPR 1.22, 95% CI 1.01–1.47). Clients on Protease-based regimen were less likely to suppress than
those on Efavirenz or Nevirapine-based regimens (aPR 0.11, 95% CI 0.08–0.15). All the interviewed healthcare workers
lauded IAC for improving ART adherence. However, patient and health care system related factors hindered adherence
during IAC.
Description
Keywords
Intensive adherence counseling, People living with HIV, Unsuppressed viral load, Public HIV care center, Uganda
Citation
Lukyamuzi, Z., Etajak, S., Katairo, T., Mukunya, D., Tetui, M., Ssenyonjo, A., & Wanyenze, R. K. (2021). Effect and implementation experience of intensive adherence counseling in a public HIV care center in Uganda: a mixed-methods study. BMC infectious diseases, 21(1), 1-15.https://doi.org/10.1186/s12879-021-06862-6