Community-based ART distribution system can effectively facilitate long-term program retention and low-rates of death and virologic failure in rural Uganda
Identifieur interne : 001806 ( Main/Exploration ); précédent : 001805; suivant : 001807Community-based ART distribution system can effectively facilitate long-term program retention and low-rates of death and virologic failure in rural Uganda
Auteurs : Stephen Okoboi [Ouganda] ; Erin Ding [Canada] ; Steven Persuad [Canada] ; Jonathan Wangisi [Ouganda] ; Josephine Birungi [Ouganda] ; Susan Shurgold [Canada] ; Darius Kato [Ouganda] ; Maureen Nyonyintono [Ouganda] ; Aggrey Egessa [Ouganda] ; Celestin Bakanda [Ouganda] ; Paula Munderi [Ouganda] ; Pontiano Kaleebu [Ouganda] ; David M. Moore [Canada]Source :
- AIDS Research and Therapy [ 1742-6405 ] ; 2015.
Abstract
Community-drug distribution point is a care model for stable patients in the community designed to make ART delivery more efficient for the health system and provide appropriate support to encourage long-term retention of patients. We examined program retention among ART program participants in rural Uganda, which has used a community-based distribution model of ART delivery since 2004.
We analyzed data of all patients >18 years who initiated ART in Jinja, Ugandan site of The AIDS Support Organization between January 1, 2004 and July 31, 2009. Participants attended clinic or outreach visits every 2–3 months and had CD4 cell counts measured every 6 months. Retention to care was defined as any patient with at least one visit in the 6 months before June 1, 2013. We then identified participants with at least one visit in the 6 months before June 1, 2013 and examined associations with mortality and lost-to-follow-up (LTFU). Participants with >4 years of follow up during August, 2012 to May, 2013 had viral load conducted, since no routine viral load testing was available.
A total of 3345 participants began ART during 2004–2009. The median time on ART in June 2013 was 5.69 years. A total of 1335 (40 %) were residents of Jinja district and 2005 (60 %) resided in outlying districts. Of these, 2322 (69 %) were retained in care, 577 (17 %) died, 161 (5 %) transferred out and 285 (9 %) were LTFU. Factors associated with mortality or LTFU included male gender, [Adjusted Hazard Ratio (AHR) = 1.56; 95 % CI 1.28–1.9], CD4 cell count <50 cells/μL (AHR = 4.09; 95 % CI 3.13–5.36) or 50–199 cells/μL (AHR = 1.86; 95 % CI 1.46–2.37); ART initiation and WHO stages 3 (AHR = 1.35; 95 % CI 1.1–1.66) or 4 (AHR = 1.74; 95 % CI 1.23–2.45). Residence outside of Jinja district was not associated with mortality/LTFU (p value = 0.562). Of 870 participants who had VL tests, 756 (87 %) had VLs <50 copies/mL.
Community-based ART distribution systems can effectively mitigate the barriers to program retention and result in good rates of virologic suppression.
Url:
DOI: 10.1186/s12981-015-0077-4
PubMed: 26566390
PubMed Central: 4642676
Affiliations:
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Uganda</nlm:aff><country xml:lang="fr">Ouganda</country><wicri:regionArea>Mulago Hospital Complex, The AIDS Support Organization (TASO), P.O BOX 10443, Kampala</wicri:regionArea><wicri:noRegion>Kampala</wicri:noRegion></affiliation></author><author><name sortKey="Munderi, Paula" sort="Munderi, Paula" uniqKey="Munderi P" first="Paula" last="Munderi">Paula Munderi</name><affiliation wicri:level="1"><nlm:aff id="Aff4">MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda</nlm:aff><country xml:lang="fr">Ouganda</country><wicri:regionArea>MRC/UVRI Uganda Research Unit on AIDS, Entebbe</wicri:regionArea><wicri:noRegion>Entebbe</wicri:noRegion></affiliation></author><author><name sortKey="Kaleebu, Pontiano" sort="Kaleebu, Pontiano" uniqKey="Kaleebu P" first="Pontiano" last="Kaleebu">Pontiano Kaleebu</name><affiliation wicri:level="1"><nlm:aff id="Aff4">MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda</nlm:aff><country xml:lang="fr">Ouganda</country><wicri:regionArea>MRC/UVRI Uganda 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sortKey="Okoboi, Stephen" sort="Okoboi, Stephen" uniqKey="Okoboi S" first="Stephen" last="Okoboi">Stephen Okoboi</name><affiliation wicri:level="1"><nlm:aff id="Aff1">Mulago Hospital Complex, The AIDS Support Organization (TASO), P.O BOX 10443, Kampala, Uganda</nlm:aff><country xml:lang="fr">Ouganda</country><wicri:regionArea>Mulago Hospital Complex, The AIDS Support Organization (TASO), P.O BOX 10443, Kampala</wicri:regionArea><wicri:noRegion>Kampala</wicri:noRegion></affiliation></author><author><name sortKey="Ding, Erin" sort="Ding, Erin" uniqKey="Ding E" first="Erin" last="Ding">Erin Ding</name><affiliation wicri:level="1"><nlm:aff id="Aff2">The BC Centre for Excellence in HIV/AIDS, Vancouver, Canada</nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea>The BC Centre for Excellence in HIV/AIDS, Vancouver</wicri:regionArea><wicri:noRegion>Vancouver</wicri:noRegion></affiliation></author><author><name sortKey="Persuad, Steven" sort="Persuad, Steven" uniqKey="Persuad S" first="Steven" last="Persuad">Steven Persuad</name><affiliation wicri:level="1"><nlm:aff id="Aff3">Faculty of Medicine, University of British Columbia, Vancouver, Canada</nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea>Faculty of Medicine, University of British Columbia, Vancouver</wicri:regionArea><wicri:noRegion>Vancouver</wicri:noRegion></affiliation></author><author><name sortKey="Wangisi, Jonathan" sort="Wangisi, Jonathan" uniqKey="Wangisi J" first="Jonathan" last="Wangisi">Jonathan Wangisi</name><affiliation wicri:level="1"><nlm:aff id="Aff1">Mulago Hospital Complex, The AIDS Support Organization (TASO), P.O BOX 10443, Kampala, Uganda</nlm:aff><country xml:lang="fr">Ouganda</country><wicri:regionArea>Mulago Hospital Complex, The AIDS Support Organization (TASO), P.O BOX 10443, Kampala</wicri:regionArea><wicri:noRegion>Kampala</wicri:noRegion></affiliation></author><author><name sortKey="Birungi, Josephine" sort="Birungi, Josephine" uniqKey="Birungi J" first="Josephine" last="Birungi">Josephine Birungi</name><affiliation wicri:level="1"><nlm:aff id="Aff1">Mulago Hospital Complex, The AIDS Support Organization (TASO), P.O BOX 10443, Kampala, Uganda</nlm:aff><country xml:lang="fr">Ouganda</country><wicri:regionArea>Mulago Hospital Complex, The AIDS Support Organization (TASO), P.O BOX 10443, Kampala</wicri:regionArea><wicri:noRegion>Kampala</wicri:noRegion></affiliation></author><author><name sortKey="Shurgold, Susan" sort="Shurgold, Susan" uniqKey="Shurgold S" first="Susan" last="Shurgold">Susan Shurgold</name><affiliation wicri:level="1"><nlm:aff id="Aff2">The BC Centre for Excellence in HIV/AIDS, Vancouver, Canada</nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea>The BC Centre for Excellence in HIV/AIDS, Vancouver</wicri:regionArea><wicri:noRegion>Vancouver</wicri:noRegion></affiliation></author><author><name sortKey="Kato, Darius" sort="Kato, Darius" uniqKey="Kato D" first="Darius" last="Kato">Darius Kato</name><affiliation wicri:level="1"><nlm:aff id="Aff1">Mulago Hospital Complex, The AIDS Support Organization (TASO), P.O BOX 10443, Kampala, Uganda</nlm:aff><country xml:lang="fr">Ouganda</country><wicri:regionArea>Mulago Hospital Complex, The AIDS Support Organization (TASO), P.O BOX 10443, Kampala</wicri:regionArea><wicri:noRegion>Kampala</wicri:noRegion></affiliation></author><author><name sortKey="Nyonyintono, Maureen" sort="Nyonyintono, Maureen" uniqKey="Nyonyintono M" first="Maureen" last="Nyonyintono">Maureen Nyonyintono</name><affiliation wicri:level="1"><nlm:aff id="Aff1">Mulago Hospital Complex, The AIDS Support Organization (TASO), P.O BOX 10443, Kampala, Uganda</nlm:aff><country xml:lang="fr">Ouganda</country><wicri:regionArea>Mulago Hospital Complex, The AIDS Support Organization (TASO), P.O BOX 10443, Kampala</wicri:regionArea><wicri:noRegion>Kampala</wicri:noRegion></affiliation></author><author><name sortKey="Egessa, Aggrey" sort="Egessa, Aggrey" uniqKey="Egessa A" first="Aggrey" last="Egessa">Aggrey Egessa</name><affiliation wicri:level="1"><nlm:aff id="Aff1">Mulago Hospital Complex, The AIDS Support Organization (TASO), P.O BOX 10443, Kampala, Uganda</nlm:aff><country xml:lang="fr">Ouganda</country><wicri:regionArea>Mulago Hospital Complex, The AIDS Support Organization (TASO), P.O BOX 10443, Kampala</wicri:regionArea><wicri:noRegion>Kampala</wicri:noRegion></affiliation></author><author><name sortKey="Bakanda, Celestin" sort="Bakanda, Celestin" uniqKey="Bakanda C" first="Celestin" last="Bakanda">Celestin Bakanda</name><affiliation wicri:level="1"><nlm:aff id="Aff1">Mulago Hospital Complex, The AIDS Support Organization (TASO), P.O BOX 10443, Kampala, Uganda</nlm:aff><country xml:lang="fr">Ouganda</country><wicri:regionArea>Mulago Hospital Complex, The AIDS Support Organization (TASO), P.O BOX 10443, Kampala</wicri:regionArea><wicri:noRegion>Kampala</wicri:noRegion></affiliation></author><author><name sortKey="Munderi, Paula" sort="Munderi, Paula" uniqKey="Munderi P" first="Paula" last="Munderi">Paula Munderi</name><affiliation wicri:level="1"><nlm:aff id="Aff4">MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda</nlm:aff><country xml:lang="fr">Ouganda</country><wicri:regionArea>MRC/UVRI Uganda Research Unit on AIDS, Entebbe</wicri:regionArea><wicri:noRegion>Entebbe</wicri:noRegion></affiliation></author><author><name sortKey="Kaleebu, Pontiano" sort="Kaleebu, Pontiano" uniqKey="Kaleebu P" first="Pontiano" last="Kaleebu">Pontiano Kaleebu</name><affiliation wicri:level="1"><nlm:aff id="Aff4">MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda</nlm:aff><country xml:lang="fr">Ouganda</country><wicri:regionArea>MRC/UVRI Uganda Research Unit on AIDS, Entebbe</wicri:regionArea><wicri:noRegion>Entebbe</wicri:noRegion></affiliation></author><author><name sortKey="Moore, David M" sort="Moore, David M" uniqKey="Moore D" first="David M." last="Moore">David M. Moore</name><affiliation wicri:level="1"><nlm:aff id="Aff2">The BC Centre for Excellence in HIV/AIDS, Vancouver, Canada</nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea>The BC Centre for Excellence in HIV/AIDS, Vancouver</wicri:regionArea><wicri:noRegion>Vancouver</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="Aff3">Faculty of Medicine, University of British Columbia, Vancouver, Canada</nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea>Faculty of Medicine, University of British Columbia, Vancouver</wicri:regionArea><wicri:noRegion>Vancouver</wicri:noRegion></affiliation></author></analytic><series><title level="j">AIDS Research and Therapy</title><idno type="eISSN">1742-6405</idno><imprint><date when="2015">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Community-drug distribution point is a care model for stable patients in the community designed to make ART delivery more efficient for the health system and provide appropriate support to encourage long-term retention of patients. We examined program retention among ART program participants in rural Uganda, which has used a community-based distribution model of ART delivery since 2004.</p></sec><sec><title>Methods</title><p>We analyzed data of all patients >18 years who initiated ART in Jinja, Ugandan site of The AIDS Support Organization between January 1, 2004 and July 31, 2009. Participants attended clinic or outreach visits every 2–3 months and had CD4 cell counts measured every 6 months. Retention to care was defined as any patient with at least one visit in the 6 months before June 1, 2013. We then identified participants with at least one visit in the 6 months before June 1, 2013 and examined associations with mortality and lost-to-follow-up (LTFU). Participants with >4 years of follow up during August, 2012 to May, 2013 had viral load conducted, since no routine viral load testing was available.</p></sec><sec><title>Results</title><p>A total of 3345 participants began ART during 2004–2009. The median time on ART in June 2013 was 5.69 years. A total of 1335 (40 %) were residents of Jinja district and 2005 (60 %) resided in outlying districts. Of these, 2322 (69 %) were retained in care, 577 (17 %) died, 161 (5 %) transferred out and 285 (9 %) were LTFU. Factors associated with mortality or LTFU included male gender, [Adjusted Hazard Ratio (AHR) = 1.56; 95 % CI 1.28–1.9], CD4 cell count <50 cells/μL (AHR = 4.09; 95 % CI 3.13–5.36) or 50–199 cells/μL (AHR = 1.86; 95 % CI 1.46–2.37); ART initiation and WHO stages 3 (AHR = 1.35; 95 % CI 1.1–1.66) or 4 (AHR = 1.74; 95 % CI 1.23–2.45). Residence outside of Jinja district was not associated with mortality/LTFU (p value = 0.562). Of 870 participants who had VL tests, 756 (87 %) had VLs <50 copies/mL.</p></sec><sec><title>Conclusion</title><p>Community-based ART distribution systems can effectively mitigate the barriers to program retention and result in good rates of virologic suppression.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Gill, Cj" uniqKey="Gill C">CJ Gill</name></author><author><name sortKey="Hamer, D" uniqKey="Hamer D">D Hamer</name></author><author><name sortKey="Simon, Jl" uniqKey="Simon J">JL Simon</name></author><author><name sortKey="Thea, Dm" uniqKey="Thea D">DM Thea</name></author><author><name sortKey="Sabin, L" uniqKey="Sabin L">L Sabin</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lawn, Sd" uniqKey="Lawn S">SD Lawn</name></author><author><name sortKey="Myer, L" uniqKey="Myer L">L Myer</name></author><author><name sortKey="Orrell, C" uniqKey="Orrell C">C 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Kanyama</name></author><author><name sortKey="Namarika, Dc" uniqKey="Namarika D">DC Namarika</name></author><author><name sortKey="Weigel, R" uniqKey="Weigel R">R Weigel</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Stringer, Js" uniqKey="Stringer J">JS Stringer</name></author><author><name sortKey="Zulu, I" uniqKey="Zulu I">I Zulu</name></author><author><name sortKey="Levy, J" uniqKey="Levy J">J Levy</name></author><author><name sortKey="Stringer, Em" uniqKey="Stringer E">EM Stringer</name></author><author><name sortKey="Mwango, A" uniqKey="Mwango A">A Mwango</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Tomori, C" uniqKey="Tomori C">C Tomori</name></author><author><name sortKey="Kennedy, Ce" uniqKey="Kennedy C">CE Kennedy</name></author><author><name sortKey="Brahmbhatt, H" uniqKey="Brahmbhatt H">H Brahmbhatt</name></author><author><name sortKey="Wagman, Ja" uniqKey="Wagman J">JA 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uniqKey="Harling G">G Harling</name></author><author><name sortKey="Orrell, C" uniqKey="Orrell C">C Orrell</name></author><author><name sortKey="Bekker, Lg" uniqKey="Bekker L">LG Bekker</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Morgan, D" uniqKey="Morgan D">D Morgan</name></author><author><name sortKey="Mahe, C" uniqKey="Mahe C">C Mahe</name></author><author><name sortKey="Mayanja, B" uniqKey="Mayanja B">B Mayanja</name></author><author><name sortKey="Okongo, Jm" uniqKey="Okongo J">JM Okongo</name></author><author><name sortKey="Lubega, R" uniqKey="Lubega R">R Lubega</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lawn, Sd" uniqKey="Lawn S">SD Lawn</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Rasschaert, F" uniqKey="Rasschaert F">F Rasschaert</name></author><author><name sortKey="Decroo, T" uniqKey="Decroo T">T Decroo</name></author><author><name sortKey="Remartinez, D" uniqKey="Remartinez D">D Remartinez</name></author><author><name sortKey="Telfer, B" uniqKey="Telfer B">B Telfer</name></author><author><name sortKey="Lessitala, F" uniqKey="Lessitala F">F Lessitala</name></author><author><name sortKey="Van, Biot M" uniqKey="Van B">Biot M Van</name></author><author><name sortKey="Damme, W" uniqKey="Damme W">W Damme</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Bisson, Gp" uniqKey="Bisson G">GP Bisson</name></author><author><name sortKey="Frank, I" uniqKey="Frank I">I Frank</name></author><author><name sortKey="Gross, R" uniqKey="Gross R">R Gross</name></author><author><name sortKey="Lo Re, V" uniqKey="Lo Re V">V Lo Re</name></author><author><name sortKey="Strom, Jb" uniqKey="Strom J">JB Strom</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Laurent, C" uniqKey="Laurent C">C Laurent</name></author><author><name sortKey="Meilo, H" uniqKey="Meilo H">H Meilo</name></author><author><name sortKey="Guiard Schmid, Jb" uniqKey="Guiard Schmid J">JB Guiard-Schmid</name></author><author><name sortKey="Mapoure, Y" uniqKey="Mapoure Y">Y Mapoure</name></author><author><name sortKey="Noel, Jm" uniqKey="Noel J">JM Noel</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Decroo, T" uniqKey="Decroo T">T Decroo</name></author><author><name sortKey="Koole, O" uniqKey="Koole O">O Koole</name></author><author><name sortKey="Remartinez, D" uniqKey="Remartinez D">D Remartinez</name></author><author><name sortKey="Dos Santos, N" uniqKey="Dos Santos N">N dos Santos</name></author><author><name sortKey="Dezembro S, S" uniqKey="Dezembro S S">S Dezembro S</name></author><author><name sortKey="Jofrisse, M" uniqKey="Jofrisse M">M Jofrisse</name></author><author><name sortKey="Rasschaert, F" uniqKey="Rasschaert F">F Rasschaert</name></author><author><name sortKey="Biot, M" uniqKey="Biot M">M Biot</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Ostermann, J" uniqKey="Ostermann J">J Ostermann</name></author><author><name sortKey="Whetten, K" uniqKey="Whetten K">K Whetten</name></author><author><name sortKey="Reddy, E" uniqKey="Reddy E">E Reddy</name></author><author><name sortKey="Pence, B" uniqKey="Pence B">B Pence</name></author><author><name sortKey="Weinhold, A" uniqKey="Weinhold A">A Weinhold</name></author><author><name sortKey="Itemba, D" uniqKey="Itemba D">D Itemba</name></author><author><name sortKey="Maro, V" uniqKey="Maro V">V Maro</name></author><author><name sortKey="Mosille, E" uniqKey="Mosille E">E Mosille</name></author><author><name sortKey="Thielman, N" uniqKey="Thielman N">N Thielman</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Canada</li><li>Ouganda</li></country></list><tree><country name="Ouganda"><noRegion><name sortKey="Okoboi, Stephen" sort="Okoboi, Stephen" uniqKey="Okoboi S" first="Stephen" last="Okoboi">Stephen Okoboi</name></noRegion><name sortKey="Bakanda, Celestin" sort="Bakanda, Celestin" uniqKey="Bakanda C" first="Celestin" last="Bakanda">Celestin Bakanda</name><name sortKey="Birungi, Josephine" sort="Birungi, Josephine" uniqKey="Birungi J" first="Josephine" last="Birungi">Josephine Birungi</name><name sortKey="Egessa, Aggrey" sort="Egessa, Aggrey" uniqKey="Egessa A" first="Aggrey" last="Egessa">Aggrey Egessa</name><name sortKey="Kaleebu, Pontiano" sort="Kaleebu, Pontiano" uniqKey="Kaleebu P" first="Pontiano" last="Kaleebu">Pontiano Kaleebu</name><name sortKey="Kato, Darius" sort="Kato, Darius" uniqKey="Kato D" first="Darius" last="Kato">Darius Kato</name><name sortKey="Munderi, Paula" sort="Munderi, Paula" uniqKey="Munderi P" first="Paula" last="Munderi">Paula Munderi</name><name sortKey="Nyonyintono, Maureen" sort="Nyonyintono, Maureen" uniqKey="Nyonyintono M" first="Maureen" last="Nyonyintono">Maureen Nyonyintono</name><name sortKey="Wangisi, Jonathan" sort="Wangisi, Jonathan" uniqKey="Wangisi J" first="Jonathan" last="Wangisi">Jonathan Wangisi</name></country><country name="Canada"><noRegion><name sortKey="Ding, Erin" sort="Ding, Erin" uniqKey="Ding E" first="Erin" last="Ding">Erin Ding</name></noRegion><name sortKey="Moore, David M" sort="Moore, David M" uniqKey="Moore D" first="David M." last="Moore">David M. Moore</name><name sortKey="Moore, David M" sort="Moore, David M" uniqKey="Moore D" first="David M." last="Moore">David M. Moore</name><name sortKey="Persuad, Steven" sort="Persuad, Steven" uniqKey="Persuad S" first="Steven" last="Persuad">Steven Persuad</name><name sortKey="Shurgold, Susan" sort="Shurgold, Susan" uniqKey="Shurgold S" first="Susan" last="Shurgold">Susan Shurgold</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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