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. 2018 Mar 23;18(1):138.
doi: 10.1186/s12879-018-3042-8.

Assessing linkage to and retention in care among HIV patients in Uganda and identifying opportunities for health systems strengthening: a descriptive study

Caroline E Boeke  1   2 , Vennie Nabitaka  3 , Andrea Rowan  3 , Katherine Guerra  4 , Arnold Kabbale  3 , Barbara Asire  5 , Eleanor Magongo  5 , Pamela Nawaggi  3 , Vivienne Mulema  3 , Betty Mirembe  3 , Victor Bigira  3 , Andrew Musoke  3 , Cordelia Katureebe  5
Affiliations

Assessing linkage to and retention in care among HIV patients in Uganda and identifying opportunities for health systems strengthening: a descriptive study

Caroline E Boeke et al. BMC Infect Dis. .

Abstract

Background: While antiretroviral therapy (ART) availability for HIV patients has increased dramatically in Uganda, patient linkage to and retention in care remains a challenge. We assessed patterns of engagement in care in 20 Ugandan health facilities with low retention based on national reporting.

Methods: We assessed patient linkage to care (defined as registering for pre-ART or ART care at the facility within 1 month of HIV diagnosis) and 6-month retention in care (having a visit 3-6 months after ART initiation) and associations with patient-/facility-level factors using multivariate logistic regression.

Results: Among 928 newly HIV-diagnosed patients, only 53.0% linked to care within 1 month. Of these, 83.7% linked within 1 week. Among 678 newly initiated ART patients, 14.5% never returned for a follow-up visit at the facility. Retention was 71.7% according to our primary definition but much lower if stricter definitions were used. Most patients were already falling behind appointment schedules at their first ART follow-up (median: 28 days post-initiation vs. recommended 14 days). 27.3% of newly-initiated patients had follow-up appointments scheduled 45+ days apart rather than monthly per national guidelines. Linkage and retention were not strongly correlated with each other within facilities (rs = 0.06; p = 0.82). Females, adolescents, and patients in rural settings tended to have lower linkage and retention in multivariable-adjusted models.

Conclusions: Linkage support may be most critical immediately after testing positive, as patients are less likely to link over time. More information is needed on reasons for appointment schedules by clinicians and implications on retention.

Trial registration: This study was registered in the Pan African Clinical Trial Registry database (#PACTR201611001756166).

Keywords: Africa; HIV; Linkage to care; Retention in care; Service delivery.

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Conflict of interest statement

Ethics approval and consent to participate

This Human Research study was approved by Makerere University School of Health Sciences Research and Ethics Committee (protocol #2016-032), the Uganda National Council for Science and Technology (#HS 2106), and Chesapeake IRB (#Pro00018902). Makerere University School of Health Sciences Research and Ethics Committee and Chesapeake IRB waived the need for informed consent for the facility-based retrospective data collection. Permission was obtained from the Ministry of Health, District Health Office, and facility in-charge to review patient records and gather data at each facility. Because patient data needed to be linked across data sources using patient ID number and name, data were not de-identified for analysis, but datasets were encrypted, password-protected, and accessible only to authorized members of the core study team.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Time to linkage to pre-ART or ART care (weeks) among the 516 patients who linked to care within 3 months of HIV diagnosis
Fig. 2
Fig. 2
Kaplan-Meier curves showing the proportion of patients in care over time. Patients with a visit in the final 35 days of follow-up were considered to be in care at 180 days
See this image and copyright information in PMC

References

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