Impact of Differentiated Service Delivery Models on Retention and Viral Load Suppression among Art Clients in Communities in Eastern Uganda
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Date
2022
Journal Title
Journal ISSN
Volume Title
Publisher
Research Square
Abstract
Although Uganda rolled out Differentiated Service Delivery models in 2017 to improve retention and achieve viral load suppression,
these have remained low relative to UNAIDs targets of 95-95-95 by 2030. We determined the impact of facility and community DSD
Models on viral load suppression and retention among ART clients in Katakwi district in North Eastern Uganda.
Methods;
A retrospective cohort study of all ART clients in the different approaches of DSD models who were active by 2017, were followed up
to 2020. The primary outcomes were retention and viral load suppression of ART clients in different approaches. Eight health facilities
providing ART services were purposively sampled and 771 ART clients were sampled out by simple random sampling out of 4742 total
population on ART in Katakwi district. We analysed retention, viral load suppression, and their determinants by logistic regression
method using STATA.
Results;
A total of 771 participants were sampled of whom 42.7% were male and 57.3% were females, with the mean age being 40 years. While
retention rates at 95% CI of participants were 99.35% at 12 months, 94.03 at 24 months, 89.88% at 36months, and 84.57% at
48months. The viral load suppression rates were57.3% at 12 months, 70.3% at 24 months, 70.3% at 36 months, and 69% at 48
months. Retention was higher in the community-based DSD model as compared with the facility-based model. Viral load suppression
was higher in the community-based DSD models in which CDDP had the highest achievement (92%) followed by CCLAD (79%)
compared to the facility-based DSD models in which FBIM performance (34.3%) was far below the set standard of 95%, followed by
FBG (65%) with FTDR having relatively better performance (80.9%).Being 40–59 years, receiving care from the general hospital, being
married, having good current adherence, being on the first line of the current regimen, and being a female as other predictors of viral
load suppression whereas being 40–59 years of age, having good current adherence, being on the current first-line regimen, and
having no comorbidities were predictors of good retention.
Conclusions;
Both facility and community-based DSD models have led to improved retention and viral load suppression however community-based
models have shown to be more effective than facility-based models through mitigation of barriers to effective HIV/AIDS care of
patients on ART. Viral load suppression remained low below the UNAIDs target of 95% by 2030 albeit it improved over time.
Description
Keywords
Differentiated Service Delivery models, HIV/AIDS, Viral load suppression, Retention in care
Citation
Brian, J., Waiswa, S., Balinaine, J., Lomuria, R., Nabutanyi, G. G., Ongala, E., ... & Nekaka, R. (2022). Impact of Differentiated Service Delivery Models on Retention and Viral Load Suppression among Art Clients in Communities in Eastern Uganda. https://doi.org/10.21203/rs.3.rs-1427840/v1