Impact of an intensive facility-community case management intervention on 6-month HIV outcomes among select key and priority populations in Uganda
Abstract Introduction Key and priority populations (with risk behaviours and health inequities) are disproportionately affected by HIV in Uganda. We evaluated the impact of an intensive case management intervention on HIV treatment outcomes in Kalangala District, predominantly inhabited by fisher fo...
| Main Authors: | , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-12-01
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| Series: | AIDS Research and Therapy |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12981-022-00486-9 |
| _version_ | 1811188713789587456 |
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| author | David B. Meya Agnes N. Kiragga Elizabeth Nalintya Grace Banturaki Joan Akullo Phillip Kalyesubula Patrick Sessazi Hillary Bitakalamire Joseph Kabanda Julius N. Kalamya Alice Namale Moses Bateganya Joseph Kagaayi Steve Gutreuter Michelle R. Adler Kiren Mitruka |
| author_facet | David B. Meya Agnes N. Kiragga Elizabeth Nalintya Grace Banturaki Joan Akullo Phillip Kalyesubula Patrick Sessazi Hillary Bitakalamire Joseph Kabanda Julius N. Kalamya Alice Namale Moses Bateganya Joseph Kagaayi Steve Gutreuter Michelle R. Adler Kiren Mitruka |
| author_sort | David B. Meya |
| collection | DOAJ |
| description | Abstract Introduction Key and priority populations (with risk behaviours and health inequities) are disproportionately affected by HIV in Uganda. We evaluated the impact of an intensive case management intervention on HIV treatment outcomes in Kalangala District, predominantly inhabited by fisher folk and female sex workers. Methods This quasi-experimental pre-post intervention evaluation included antiretroviral therapy naïve adults aged ≥ 18 years from six health facilities in the pre-intervention (Jan 1, 2017–December 31, 2017) and intervention phase (June 13, 2018–June 30, 2019). The primary outcomes were 6-month retention and viral suppression (VS) before and after implementation of the intervention involving facility and community case managers who supported participants through at least the first three months of ART. We used descriptive statistics to compared the characteristics, overall outcomes (i.e., retention, lost to follow up, died), and VS of participants by phase, and used mixed-effects logistic regression models to determine factors associated with 6-month retention in care. Marginal (averaging over facilities) probabilities of retention were computed from the final multivariable model. Results We enrolled 606 and 405 participants in the pre-intervention and intervention phases respectively. Approximately 75% of participants were aged 25–44 years, with similar age and gender distributions among phases. Approximately 46% of participants in the intervention were fisher folk and 9% were female sex workers. The adjusted probability of 6-month retention was higher in the intervention phase, 0.83 (95% CI: 0.77–0.90) versus pre-intervention phase, 0.73 (95% CI: 0.69–0.77, p = 0.03). The retention probability increased from 0.59 (0.49–0.68) to 0.73 (0.59–0.86), p = 0.03 among participants aged 18–24 years, and from 0.75 (0.71–0.78) to 0.85 (0.78–0.91), p = 0.03 among participants aged ≥ 25 years. VS (< 1,000 copies/mL) was approximately 87% in both phases. Conclusions After implementation of the case management intervention, we observed significant improvement in 6-month retention in all age groups of a highly mobile population of predominantly fisher folk. |
| first_indexed | 2024-04-11T14:24:14Z |
| format | Article |
| id | doaj.art-3da8df7059b04cd388912d38c9f38de2 |
| institution | Directory Open Access Journal |
| issn | 1742-6405 |
| language | English |
| last_indexed | 2024-04-11T14:24:14Z |
| publishDate | 2022-12-01 |
| publisher | BMC |
| record_format | Article |
| series | AIDS Research and Therapy |
| spelling | doaj.art-3da8df7059b04cd388912d38c9f38de22022-12-22T04:18:56ZengBMCAIDS Research and Therapy1742-64052022-12-011911910.1186/s12981-022-00486-9Impact of an intensive facility-community case management intervention on 6-month HIV outcomes among select key and priority populations in UgandaDavid B. Meya0Agnes N. Kiragga1Elizabeth Nalintya2Grace Banturaki3Joan Akullo4Phillip Kalyesubula5Patrick Sessazi6Hillary Bitakalamire7Joseph Kabanda8Julius N. Kalamya9Alice Namale10Moses Bateganya11Joseph Kagaayi12Steve Gutreuter13Michelle R. Adler14Kiren Mitruka15Infectious Diseases Institute, College of Health Sciences, Makerere UniversityInfectious Diseases Institute, College of Health Sciences, Makerere UniversityInfectious Diseases Institute, College of Health Sciences, Makerere UniversityInfectious Diseases Institute, College of Health Sciences, Makerere UniversityInfectious Diseases Institute, College of Health Sciences, Makerere UniversityInfectious Diseases Institute, College of Health Sciences, Makerere UniversityInfectious Diseases Institute, College of Health Sciences, Makerere UniversityKalangala District Health ServicesU.S Centers for Disease Control and PreventionU.S Centers for Disease Control and PreventionU.S Centers for Disease Control and PreventionU.S Centers for Disease Control and PreventionRakai Health SciencesU.S Centers for Disease Control and PreventionU.S Centers for Disease Control and PreventionU.S Centers for Disease Control and PreventionAbstract Introduction Key and priority populations (with risk behaviours and health inequities) are disproportionately affected by HIV in Uganda. We evaluated the impact of an intensive case management intervention on HIV treatment outcomes in Kalangala District, predominantly inhabited by fisher folk and female sex workers. Methods This quasi-experimental pre-post intervention evaluation included antiretroviral therapy naïve adults aged ≥ 18 years from six health facilities in the pre-intervention (Jan 1, 2017–December 31, 2017) and intervention phase (June 13, 2018–June 30, 2019). The primary outcomes were 6-month retention and viral suppression (VS) before and after implementation of the intervention involving facility and community case managers who supported participants through at least the first three months of ART. We used descriptive statistics to compared the characteristics, overall outcomes (i.e., retention, lost to follow up, died), and VS of participants by phase, and used mixed-effects logistic regression models to determine factors associated with 6-month retention in care. Marginal (averaging over facilities) probabilities of retention were computed from the final multivariable model. Results We enrolled 606 and 405 participants in the pre-intervention and intervention phases respectively. Approximately 75% of participants were aged 25–44 years, with similar age and gender distributions among phases. Approximately 46% of participants in the intervention were fisher folk and 9% were female sex workers. The adjusted probability of 6-month retention was higher in the intervention phase, 0.83 (95% CI: 0.77–0.90) versus pre-intervention phase, 0.73 (95% CI: 0.69–0.77, p = 0.03). The retention probability increased from 0.59 (0.49–0.68) to 0.73 (0.59–0.86), p = 0.03 among participants aged 18–24 years, and from 0.75 (0.71–0.78) to 0.85 (0.78–0.91), p = 0.03 among participants aged ≥ 25 years. VS (< 1,000 copies/mL) was approximately 87% in both phases. Conclusions After implementation of the case management intervention, we observed significant improvement in 6-month retention in all age groups of a highly mobile population of predominantly fisher folk.https://doi.org/10.1186/s12981-022-00486-9Antiretroviral therapyRetention in careKey populationsViral suppressionHIV |
| spellingShingle | David B. Meya Agnes N. Kiragga Elizabeth Nalintya Grace Banturaki Joan Akullo Phillip Kalyesubula Patrick Sessazi Hillary Bitakalamire Joseph Kabanda Julius N. Kalamya Alice Namale Moses Bateganya Joseph Kagaayi Steve Gutreuter Michelle R. Adler Kiren Mitruka Impact of an intensive facility-community case management intervention on 6-month HIV outcomes among select key and priority populations in Uganda AIDS Research and Therapy Antiretroviral therapy Retention in care Key populations Viral suppression HIV |
| title | Impact of an intensive facility-community case management intervention on 6-month HIV outcomes among select key and priority populations in Uganda |
| title_full | Impact of an intensive facility-community case management intervention on 6-month HIV outcomes among select key and priority populations in Uganda |
| title_fullStr | Impact of an intensive facility-community case management intervention on 6-month HIV outcomes among select key and priority populations in Uganda |
| title_full_unstemmed | Impact of an intensive facility-community case management intervention on 6-month HIV outcomes among select key and priority populations in Uganda |
| title_short | Impact of an intensive facility-community case management intervention on 6-month HIV outcomes among select key and priority populations in Uganda |
| title_sort | impact of an intensive facility community case management intervention on 6 month hiv outcomes among select key and priority populations in uganda |
| topic | Antiretroviral therapy Retention in care Key populations Viral suppression HIV |
| url | https://doi.org/10.1186/s12981-022-00486-9 |
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