Project: Antiretroviral therapy Outcomes, Barriers and facilitators of Adherence among individuals initiating Treatment following Test and Start guidelines in an urban HIV clinic in Uganda

Acronym ABOUT (Reference Number: TMA2016CDF-1602)
Duration 01/06/2018 - 31/05/2021
Project Topic Recent World Health Organization (WHO) guidelines recommend antiretroviral therapy (ART) initiation for everyone diagnosed with HIV regardless of CD4+ cell count and pre-exposure prophylaxis for those at substantial risk of HIV infection. However, there are fears that initiating healthy people on treatment may instead result in poor treatment outcomes due to non-adherence. We seek to assess treatment outcomes, barriers and facilitators of adherence and linkage to care among individuals initiating antiretroviral therapy (ART) under “Test and Start” guidelines in an urban HIV clinic in Uganda. Methods: This will be a mixed methods study using both qualitative and quantitative methods. The quantitative study will involve a retrospective analysis of medical records of all HIV-positive individuals (>18 years) initiated on ART under “Test and Start” at Kawaala Health Centre III between January 2017 and January 2018 followed up over two years. Participants’ longitudinal data on socio-demographic characteristics, adherence, CD4 counts, viral loads (VLs), opportunistic infections and patient retention at 6, 12 and 24 months on ART will be abstracted. We shall describe proportion of participants with viral suppression (VL =1000 copies/mL), mean adherence using selfreports, incidence of opportunistic infections, mortality rates, retention in care rates at 6, 12 and 24months. Analysis will include descriptive statistics, chi-square and t-tests and survival analysis using STATA® software to estimate time to viral suppression (VL =1000 copies/mL). Survival analysis will be used to analyse the data with STATA® software to estimate time to viral suppression (VL =1000 copies/mL). In order to assess barriers and facilitators for adherence to ART, a purposively selected sample of 24 individuals will participate in In-depth Interviews (IDIs). Participants will be classified as adherers if they reported adherence =95% with corresponding viral suppression. Non-adherers will be categorized as irregular (inconsistent or reporting adherence < 95%) and lost to follow up (LTFU). Key informant interviews (KIs) will be conducted among healthcare providers to assess their experiences with patients initiating ART under “Test and Start” guidelines. Both in-depth Interview and Key Informant sessions will be audio-recorded and transcribed. Transcripts and notes will be translated into English and the word processed text will be coded. Transcripts will be subjected to content analysis using Atlas.ti version 7.0. Expected outputs: The study question is so timely, especially towards achieving the global targets to prevent and eliminate HIV. As a country, Uganda has had three HIV treatment guideline policy changes. “Test and Start” policy guidelines require ART initiation for everyone testing HIV positive or at higher risk of HIV acquisition appear too ambitious for now especially for Uganda where majority of the population do not know their HIV status and inadequate resources to meet the ART demand for those with confirmed HIV diagnosis. Findings from this study, will help us take stock as to whether we have the capacity to move at the same pace as the rest of the world in the fight against HIV/AIDS. Additionally, findings from this study will inform interventions to address treatment adherence and linkage to care challenges especially among “healthy” individuals living with HIV infection.
Network EDCTP2
Call Career Development Fellowships 2016

Project partner

Number Name Role Country
1 Infectious Diseases Institute Limited Coordinator Uganda