Abstract
BackgroundIn 2013, Uganda adopted a test-and-treat policy for HIV patients 15 years or younger. Low retention rates among paediatric and adolescent antiretroviral therapy (ART) initiates could severely limit the impact of this new policy. This evaluation tested the impact of a differentiated care model called Family Clinic Day (FCD), a family-centered appointment scheduling and health education intervention on patient retention and adherence to monthly appointment scheduling.MethodsWe conducted a cluster randomized controlled trial, from October 2014 to March 2015. Forty-six facilities were stratified by implementing partner and facility type and randomly assigned to the control or intervention arm. Primary outcomes included the proportion of patients retained in care at 6 months and the proportion adherent to their appointment schedule at last study period scheduled visit. Data collection occurred retrospectively in May 2015. Six patient focus group discussions and 17 health workers interviews were conducted to understand perspectives on FCD successes and challenges.ResultsA total of 4,715 paediatric and adolescent patient records were collected, of which 2,679 (n = 1,319 from 23 control facilities and 1,360 from 23 intervention facilities) were eligible for inclusion. The FCD did not improve retention (aOR 1.11; 90% CI 0.63–1.97, p = 0.75), but was associated with improved adherence to last appointment schedule (aOR 1.64; 90% CI 1.27–2.11, p<0.001). Qualitative findings suggested that FCD patients benefited from health education and increased psychosocial support.ConclusionFCD scale-up in Uganda may be an effective differentiated care model to ensure patient adherence to ART clinic appointment schedules, a key aspect necessary for viral load suppression. Patient health outcomes may also benefit following an increase in knowledge based on health education, and peer support. Broad challenges facing ART clinics, such as under-staffing and poor filing systems, should be addressed in order to improve patient care.
Highlights
In Uganda, the adoption of a test-and-treat policy for HIV patients 15 years or younger in late 2013 resulted in the rapid expansion of the antiretroviral therapy (ART) eligible paediatric and adolescent population
Patient health outcomes may benefit following an increase in knowledge based on health education, and peer support
The study was conducted at government ART-accredited health center level III facilities (HCIIIs), health center level IV facilities (HCIVs), and general hospitals (GHs) across the Central 1, Central 2, Eastern and Northern regions of Uganda
Summary
In Uganda, the adoption of a test-and-treat policy for HIV patients 15 years or younger in late 2013 resulted in the rapid expansion of the ART eligible paediatric and adolescent population. When caregivers are HIV positive, their appointments may not be scheduled on the same day, leading to increased costs or difficult choices. Such burdens may present a challenge for families to remain adherent to appointments and their ART treatment regime. Low retention rates among paediatric and adolescent antiretroviral therapy (ART) initiates could severely limit the impact of this new policy. This evaluation tested the impact of a differentiated care model called Family Clinic Day (FCD), a family-centered appointment scheduling and health education intervention on patient retention and adherence to monthly appointment scheduling
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