Abstract
ObjectivesTo investigate antiretroviral therapy (ART) uptake after its introduction in 2004 in a longitudinal population-based cohort and its nested clinical cohort in rural Uganda.MethodsA HIV serosurvey of all adults aged ≥15 years is conducted annually. Two intervals were selected for analysis. Interval 1 (November 2004–October 2006) provided 2 years of follow-up to prospectively evaluate access to HIV services. Interval 2 (November 2007–October 2008) was used to evaluate current coverage of services. Logistic regression was used to identify sociodemographic factors associated with ART screening within 2 years of diagnosis. ART coverage was assessed using Weibull survival models to estimate the numbers needing ART.ResultsIn Interval 1, 636 HIV-positive adults were resident and 295 (46.4%) knew their status. Of those, 248 (84.1%) were screened for ART within 2 years of diagnosis. After adjusting for age, those who were widowed, separated or never married were more likely to be screened than those who were married. In Interval 2, 575 HIV-positive adults were residents, 322 (56.0%) knew their status, 255 (44.3%) had been screened for ART and 189 (32.9%) had started ART. Estimated ART coverage was 66%.ConclusionsIn this cohort, ART access and uptake is very high once people are diagnosed. Owing to intensive screening in the study clinic, nearly all participants who were eligible initiated ART. However, this is unlikely to reflect coverage in the general population, intensified efforts are needed to promote HIV testing, and ART screening and uptake are needed among those found to be HIV-positive.
Highlights
Antiretroviral therapy (ART) has led to the improved health of many HIV-infected people and is a cost-effective intervention, as it makes HIV infection a chronic manageable disease, allowing HIV-infected people to live well and to be socially and economically active (Badri et al 2006)
36 of those who reported receiving their results at a voluntary counselling and testing (VCT) centre had no confirmed record of diagnosis
We have identified various factors associated with uptake of ART screening after diagnosis that could be targeted in developing strategies to improve HIV care programmes
Summary
Antiretroviral therapy (ART) has led to the improved health of many HIV-infected people and is a cost-effective intervention, as it makes HIV infection a chronic manageable disease, allowing HIV-infected people to live well and to be socially and economically active (Badri et al 2006). The number of adults and children living with HIV increased from 29 million in 2001 to 33.4 million in 2008, the number of HIV-related deaths rose only from 1.9 million to 2 million over the same period, largely due to ART scale-up (UNAIDS ⁄ WHO, 2009). Barriers to ART access and uptake in Africa include misperceptions, distance to the ART providers and fear of side-effects of divorce or rejection by spouses, of stigma following HIV serostatus disclosure to friends and relatives, and of taking medicines for life (Murray et al 2009). A longstanding population-based cohort in rural Uganda and its nested clinical cohort provided the opportunity to assess ART access and uptake and to investigate possible associated demographic factors
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