Abstract
BackgroundIntensive 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.MethodsThis 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.ResultsA total of 500 records were sampled: 249 (49.8%) in the intervention period and 251 (51.2%) in the pre-intervention 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.ConclusionsThe full potential of IAC in achieving viral load suppression in this setting has not been reached due to a combination of the patient and health care system related factors. Provision of adequate IAC necessities and use of patient centered approach should be emphasized to obtain the maximum benefit of the intervention.
Highlights
Globally 38 million people were infected with human immunodeficiency virus (HIV) in 2020 [1], despite a 23% decline in new HIV infections since 2010
Despite the 38% reduction in new HIV infections in Eastern and southern Africa by the end of 2019, the region remains the most affected [1]. This is partly due to inadequate implementation of available effective strategies and interventions and this will slow the progress towards the ambitious vision of ending HIV/ AIDS by 2030 [3]
HIV viral load (VL) suppression is critical in reducing morbidity, mortality, new HIV infections, and drug resistance, and is a major strategy in ending HIV/AIDS especially in sub-Saharan Africa (SSA) [4,5,6,7,8,9]
Summary
38 million people were infected with human immunodeficiency virus (HIV) in 2020 [1], despite a 23% decline in new HIV infections since 2010. Despite the 38% reduction in new HIV infections in Eastern and southern Africa by the end of 2019, the region remains the most affected [1]. This is partly due to inadequate implementation of available effective strategies and interventions and this will slow the progress towards the ambitious vision of ending HIV/ AIDS by 2030 [3]. HIV viral load (VL) suppression is critical in reducing morbidity, mortality, new HIV infections, and drug resistance, and is a major strategy in ending HIV/AIDS especially in sub-Saharan Africa (SSA) [4,5,6,7,8,9]. This study evaluated the effect and experiences of providing IAC in an urban HIV care center in Kampala, Uganda
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