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RETURN to CARE after INTERRUPTION in TREATMENT in SOUTH-CENTRAL UGANDA

Journal Article
Published: March 10, 2025
Authors
Kagaayi J.
Kabanda J.
Reynolds S.J.
Gray R.
Nalugoda F.
Wawer M.
Chang L.W.
Nakigozi G.F.
Kankaka E.N.
Kisakye A.
Kate Grabowski M.
Elur B.
Nakityo R.B.
Sserwadda D.
Abstract

Background: Antiretroviral therapy (ART) reduces HIV-related morbidity and mortality and is essential for epidemic control. To prevent interruptions in treatment (IIT), the Masaka Region HIV Program in south-central Uganda, under PEPFAR funding, implemented client-centered care including differentiated service delivery models (DSD), appointment tracking systems, and psychosocial support. However, IIT remain a challenge. We studied correlates of return and time to return to care among clients with IIT. Methods: We analyzed clients with IIT during January 1, 2020-March 31, 2021 receiving ART at 95 facilities in 12 districts. IIT was defined as no clinical contact for >28 days from missed appointment. Follow-up by home visits and/or phone calls commenced the day of missed appointment; outcomes (i.e. returned to care, self-transferred, migrated, died, unknown) up to May 1, 2021 were included. Descriptive statistics, logistic regression, and non-parametric tests of medians were conducted for correlates of return and time to return. Results: Of 2,356 clients with IIT, 1,381 (59%) were women. Median age, ART duration and time to return were 35 years (interquartile range [IQR]: 27.2,41.7); 3.6 yrs (IQR: 1.4,6.0), and 3.3 months (IQR 2.1,5.9) respectively. Most clients 2,220 (94%) received ART in facility-vs. 6% in community-based settings; 2,128 (90%) were virologically suppressed (<1,000 copies/ml) prior to IIT. Outcomes were 1,266 (54%) returned to care, 116 (4.9%) self-transferred, 35 (1.5%) migrated, 20 (0.8%) died, 919 (39%) unknown. Return was more among: clients in facility-based models vs. community models (Odds Ratio [OR]: 4.34, Confidence Interval [CI]: 2.36-7.96, p<0.001); clients on ART for 4-6 yrs vs. those on ART < 2 yrs (OR: 1.70, CI: 1.13-2.56, p=0.011); and non-suppressed vs. suppressed clients prior to IIT (OR: 4.05, CI: 1.64-10.0, p=0.002). Time to return was longer in facility-based vs. community models (median 3.35 vs 2.97 months, p=0.032), and non-suppressed vs. suppressed clients prior to IIT (5.43 vs 3.23 months, p<0.001). Conclusion: Almost 40% could not be traced. There were higher proportions but slower return in facility-based models; 75% returned clients returned within 6 months. It is important to consider more effective procedures to mitigate IIT especially in community-based treatment models and to act quickly once IIT occurs among clients with VL-non-suppression pre-IIT and in facility-based clients.

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