Incidence of Health Facility Switching and Associations With HIV Viral Rebound Among Persons on Antiretroviral Therapy in Uganda: A Population-based Study
Year: 2023
Type: article
Study design: Observational Study
Abstract: BACKGROUND: A substantial proportion of persons on antiretroviral therapy (ART) considered lost to follow-up have actually transferred their human immunodeficiency virus (HIV) care to other facilities. However, the relationship between facility switching and virologic outcomes, including viral rebound, is poorly understood. METHODS: We used data from 40 communities (2015-2020) in the Rakai Community Cohort Study to estimate incidence of facility switching and viral rebound. Persons aged 15-49 years with serologically confirmed HIV who self-reported ART use and contributed ≥1 follow-up visit were included. Facility switching and virologic outcomes were assessed between 2 consecutive study visits (ie, index and follow-up visits, interval of approximately 18 months). Those who reported different HIV treatment facilities between index and follow-up study visits were classified as having switched facilities. Virologic outcomes included viral rebound among individuals initially suppressed (<200 copies/mL). Multivariable Poisson regression was used to estimate associations between facility switching and viral rebound. RESULTS: Overall, 2257 persons who self-reported ART use (median age, 35 years; 65% female, 92% initially suppressed) contributed 3335 visit-pairs and 5959 person-years to the analysis. Facility switching was common (4.8 per 100 person-years; 95% confidence interval [CI], 4.2-5.5) and most pronounced in persons aged <30 years and fishing community residents. Among persons suppressed at their index visit (n = 2076), incidence of viral rebound was more than twice as high in persons who switched facilities (adjusted incidence rate ratio = 2.27; 95% CI, 1.16-4.45). CONCLUSIONS: Facility switching was common and associated with viral rebound among persons initially suppressed. Investments in more agile, person-centered models for mobile clients are needed to address system inefficiencies and bottlenecks that can disrupt HIV care continuity.
Source: Clinical Infectious Diseases
DOI: 10.1093/cid/ciad773
Authors: Joseph G Rosen, Anthony Ndyanabo, Hadijja Nakawooya, Ronald M Galiwango, Robert Ssekubugu, Joseph Ssekasanvu, Seungwon Kim, Katherine B Rucinski, Gertrude Nakigozi, Fred Nalugoda, Godfrey Kigozi, Thomas C Quinn, Larry W Chang, Caitlin E Kennedy, Steven J Reynolds, Joseph Kagaayi, M Kate Grabowski
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
Awards: Understanding HIV risk and service use in hotspot Ugandan fishing communities, G1572340776, G201659893, G2672645366, G3175806859, The role of penile bacteria and inflammation in HIV susceptibility; Rakai, Uganda, CHWs, mHealth, and Combination HIV Prevention in a Hotspot: A Randomized Trial, G462800458, G4689185066, Multidisciplinary Research Training to Understand and Reduce HIV Incidence in Uganda, G731302033, G755977281, G830126741, G890594366, The Johns Hopkins Center for AIDS Research (JHU CFAR), Implementation Research to Optimize ART Delivery for Adolescents and Young Adults Living with HIV, Johns Hopkins HIV Epidemiology and Prevention Sciences Training Program, G94663013
OpenAlex ID: W4389975887