Human immunodeficiency virus care cascade among sub-populations in Rakai, Uganda: an observational study
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Date
2017
Journal Title
Journal ISSN
Volume Title
Publisher
Journal of the International AIDS Society
Abstract
To assess progress towards the UNAIDS 90–90–90 initiative targets, we examined the HIV care cascade in the
population-based Rakai Community Cohort Study (RCCS) in rural Uganda and examined differences between sub-groups.
Methods: Self-reports and clinical records were used to assess the proportion achieving each stage in the cascade. Statistical
inference based on a
2 test for categorical variables and modified Poisson regression were used to estimate prevalence risk
ratios (PRRs) and 95% confidence intervals (CI) for enrolment into care and initiating antiretroviral therapy (ART).
Results: From September 2013 through December 2015, 3,666 HIV-positive participants were identified in the RCCS. As of
December 2015, 98% had received HIV Counseling and Testing (HCT), 74% were enrolled in HIV care, and 63% had initiated
ART of whom 92% were virally suppressed after 12 months on ART. Engagement in care was lower among men than women
(enrolment in care: adjPRR 0.84, 95% CI 0.77–0.91; ART initiation: adjPRR 0.75, 95% CI 0.69–0.82), persons aged 15–24
compared to those aged 30–39 (enrolment: adjPRR 0.72, 95% CI 0.63–0.82; ART: adjPRR 0.69, 95%CI 0.60–0.80), unmarried
persons (enrolment: adjPRR 0.84, 95% CI 0.71–0.99; ART adjPRR 0.80, 95% CI 0.66–0.95), and new in-migrants (enrolment:
adjPRR 0.75, 95% CI 0.67–0.83; ART: adjPRR 0.76, 95% CI 0.67–0.85). This cohort achieved 98–65–92 towards the UNAIDS
“90–90–90” targets with an estimated 58% of the entire HIV-positive RCCS population virally suppressed.
Conclusions: This cohort achieved over 90% in both HCT and viral suppression among ART users, but only 65% in initiating
ART, likely due to both an ART eligibility criterion of <500 CD4 cells/mL and suboptimal entry into care among men, younger
individuals, and in-migrants. Interventions are needed to promote enrolment in HIV care, particular for hard-to-reach subpopulations.
Description
Keywords
HIV, Antiretroviral, HIV care cascade, Rakai, Uganda
Citation
Billioux, V. G., Chang, L. W., Reynolds, S. J., Nakigozi, G., Ssekasanvu, J., Grabowski, M. K., ... & Rakai Health Sciences Program. (2017). Human immunodeficiency virus care cascade among sub‐populations in Rakai, Uganda: an observational study. Journal of the International AIDS Society, 20(1), 21590. http://dx.doi.org/10.7448/IAS.20.1.21590