Non-uptake of viral load testing among people receiving HIV treatment in Gomba district, rural Uganda

Rita Nakalega,Ronald Makanga-Kakumba,Andrew Mujugira,Henry Debem,Flavia Matovu-Kiweewa,George Kiwanuka,Patience Atuhaire,Carolyne Akello,Joel Maena,Robert Menge,Nelson Mukiza,Cynthia Ndikuno-Kuteesa,Hajira Kataike

doi:10.1186/s12879-020-05461-1

Abstract

BackgroundViral load (VL) testing is the gold-standard approach for monitoring human immunodeficiency virus (HIV) treatment success and virologic failure, but uptake is suboptimal in resource-limited and rural settings. We conducted a cross-sectional study of risk factors for non-uptake of VL testing in rural Uganda.MethodsWe conducted a cross-sectional analysis of uptake of VL testing among randomly selected people with HIV (PWH) receiving anti-retroviral treatment (ART) for at least 6 months at all eight primary health centers in Gomba district, rural Uganda. Socio-demographic and clinical data were extracted from medical records for the period January to December 2017. VL testing was routinely performed 6 months after ART initiation and 12 months thereafter for PWH stable on ART. We used descriptive statistics and multivariable logistic regression to evaluate factors associated with non-uptake of VL testing (the primary outcome).ResultsOf 414 PWH, 60% were female, and the median age was 40 years (interquartile range [IQR] 31–48). Most (62.3%) had been on ART > 2 years, and the median duration of treatment was 34 months (IQR 14–55). Thirty three percent did not receive VL testing: 36% of women and 30% of men. Shorter duration of ART (≤2 years) (adjusted odds ratio [AOR] 2.38; 95% CI:1.37–4.12; p = 0.002), younger age 16–30 years (AOR 2.74; 95% CI:1.44–5.24; p = 0.002) and 31–45 years (AOR 1.92; 95% CI 1.12–3.27; p = 0.017), and receipt of ART at Health Center IV (AOR 2.85; 95% CI: 1.78–4.56; p < 0.001) were significantly associated with non-uptake of VL testing.ConclusionsOne-in-three PWH on ART missed VL testing in rural Uganda. Strategies to improve coverage of VL testing, such as VL focal persons to flag missed tests, patient education and demand creation for VL testing are needed, particularly for recent ART initiates and younger persons on treatment, in order to attain the third Joint United Nations Program on HIV/AIDS (UNAIDS) 95–95-95 target – virologic suppression for 95% of PWH on ART.

Highlights

Eastern and Southern Africa is the epicenter of the global human immunodeficiency virus (HIV) epidemic, accounting for 800,000 (47%) of the 1.7 million new HIV infections globally in 2018 [1, 2]
This study aimed to describe factors associated with non-uptake of Viral load (VL) testing among people with HIV (PWH) in Gomba district, Uganda
Relative to older age (> 46 years), younger age were significantly associated with non-uptake of VL testing uptake in univariate analysis (Table 1). Those on anti-retroviral treatment (ART) ≤2 years were more likely to have VL testing non-uptake compared to those on ART > 4 years

Summary

Introduction

Eastern and Southern Africa is the epicenter of the global HIV epidemic, accounting for 800,000 (47%) of the 1.7 million new HIV infections globally in 2018 [1, 2]. Between 2010 and 2018, the number of new HIV infections in Uganda decreased from 92,000 to 53,000, a 43% reduction [1]. Despite these gains, Uganda is not on track to reach the UNAIDS 95–95-95 targets for HIV epidemic control i.e., 95% of people with HIV (PWH) knowing their HIV status; 95% of people who know their status on treatment; and 95% of people on treatment with suppressed viral loads by 2030 [3]. Viral load (VL) testing is the gold-standard approach for monitoring human immunodeficiency virus (HIV) treatment success and virologic failure, but uptake is suboptimal in resource-limited and rural settings. We conducted a cross-sectional study of risk factors for non-uptake of VL testing in rural Uganda

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