Abstract
BackgroundImmediate uptake of antiretroviral therapy (ART) after an HIV-positive diagnosis (Test and Treat) is now being implemented in Uganda. Data are limited on lost to follow-up (LTFU) in high-risk cohorts that have initiated ‘Test and Treat’. We describe LTFU in a cohort of women of high-risk sexual behaviour who initiated ART under “Test and Treat”.MethodsWe performed a retrospective cohort study of participant records at the Good Health for Women Project (GHWP) clinic, a clinic in Kampala for women at high-risk of HIV-infection. We included HIV positive women ≥18 years who initiated ART at GHWP between August 2014 and March 2018. We defined LTFU as not taking an ART refill for ≥3 months from the last clinic appointment among those not registered as dead or transferred to another clinic. We used the Kaplan-Meier technique to estimate time to LTFU after ART initiation. Predictors of LTFU were assessed using a multivariable Cox proportional hazards model.ResultsThe mean (±SD) age of the 293 study participants was 30.3 (± 6.5) years, with 274 (94%) reporting paid sex while 38 (13%) had never tested for HIV before enrolment into GHWP. LTFU within the first year of ART initiation was 16% and the incidence of LTFU was estimated at 12.7 per 100 person-years (95%CI 9.90–16.3). In multivariable analysis, participants who reported sex work as their main job at ART initiation (Adjusted Hazards Ratio [aHR] =1.95, 95%CI 1.10–3.45), having baseline WHO clinical stage III or IV (aHR = 2.75, 95% CI 1.30–5.79) were more likely to be LTFU.ConclusionLTFU in this cohort is high. Follow up strategies are required to support women on Test and Treat to remain on treatment, especially those who engage in sex work and those who initiate ART at a later stage of disease.
Highlights
Immediate uptake of antiretroviral therapy (ART) after an Human Immunodeficiency Virus (HIV)-positive diagnosis (Test and Treat) is being implemented in Uganda
In Uganda, by the end of 2018, it was estimated that 1.4 million people were living with HIV of whom 73% were on ART and an estimated 23,000 Ugandans had died of HIV-related illnesses [1]
Between August 2014 and March 2018, 3062 participants were cumulatively registered with Good Health for Women Project (GHWP) of whom 1062 were HIV-positive and eligible for test and treat
Summary
Immediate uptake of antiretroviral therapy (ART) after an HIV-positive diagnosis (Test and Treat) is being implemented in Uganda. It is estimated that by the end of 2018, 23.3 million people were receiving antiretroviral therapy (ART) globally and that between 2000 and 2018, HIV-related deaths fell by. In Uganda, by the end of 2018, it was estimated that 1.4 million people were living with HIV of whom 73% were on ART and an estimated 23,000 Ugandans had died of HIV-related illnesses [1]. Studies have shown that ART is improving quality of life and decreasing morbidity in those receiving treatment but that the public health impact of scaling up ART may contribute significantly to prevention efforts [5, 6]. Given that the risk of HIV infections is high for key populations [9], this scale-up in ART is important to maximize the effectiveness of treatment as prevention in such populations [10]. The scale up among key populations may have an impact on the HIV epidemic, since it is estimated that in SSA they contribute between 7 and 30% of new infections [11, 12]
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