TY - JOUR
T1 - Assessing eligibility for differentiated service delivery, HIV services utilization and virologic outcomes of adult HIV-infected patients in Sierra Leone
T2 - a pre-implementation analysis
AU - Lakoh, Sulaiman
AU - Jiba, Darlinda F.
AU - Vandy, Alren O.
AU - Poveda, Eva
AU - Adekanmbi, Olukemi
AU - Murray, Mariama J.S.
AU - Deen, Gibrilla F.
AU - Sahr, Foday
AU - Hoffmann, Christopher J.
AU - Jacobson, Jeffrey M.
AU - Salata, Robert A.
AU - Yendewa, George A.
N1 - Funding Information:
GAY was supported by the Roe Green Travel Medicine and Global Health Award 2019, University Hospitals Cleveland Medical Center (Award Number J0628);Roe Green Travel Medicine Award 2019 [J0628]. We wish to thank the HIV Clinic staff at Connaught Hospital in Freetown, Sierra Leone for their dedication to patient care.
Publisher Copyright:
© 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
PY - 2021
Y1 - 2021
N2 - Background: There are limited data to help guide implementation of differentiated HIV service delivery (DSD) in resource-limited settings in sub-Saharan Africa. Objectives: This pre-implementation study sought to assess the proportion of patients eligible for DSD and HIV services utilization, as well as risk factor analysis of virologic failure in Sierra Leone. Methods: We conducted a retrospective study of adult HIV-infected patients aged 18 years and older receiving care at the largest HIV treatment center in Sierra Leone 2019–2020. Multiple logistic regression was used to identify predictors of virologic failure. Results: Of 586 unique patients reviewed, 210 (35.8%) qualified as ‘stable’ for antiretroviral therapy (ART) delivery. There was high utilization of certain HIV service programs (e.g. HIV status disclosure to partners (83%) and treatment ‘buddy’ program participation (62.8%)), while other service programs (e.g. partner testing and community HIV support group participation) had low utilization (<50%). Of 429 patients with available viral load, 277 (64.6%) were virologically suppressed. In the multivariate logistic regression analysis of risk factors of virologic failure, CD4 < 350 cells/mm3 (p = 0.009), atazanavir-based ART (p = 0.032), once monthly versus once two- or three-monthly ART dispensing (p = 0.028), history of ART switching (p = 0.02), poor adherence (p = 0.001) and not having received adherence support (p < 0.001) were independent predictors of virologic failure. Conclusion: Approximately one in three HIV-infected patients on ART were eligible for DSD. We identified gaps in HIV care (i.e. low partner testing, treatment ‘buddy’, program participation and a substantially high rate of virologic failure) that need to be addressed in preparation for full implementation of DSD in Sierra Leone.
AB - Background: There are limited data to help guide implementation of differentiated HIV service delivery (DSD) in resource-limited settings in sub-Saharan Africa. Objectives: This pre-implementation study sought to assess the proportion of patients eligible for DSD and HIV services utilization, as well as risk factor analysis of virologic failure in Sierra Leone. Methods: We conducted a retrospective study of adult HIV-infected patients aged 18 years and older receiving care at the largest HIV treatment center in Sierra Leone 2019–2020. Multiple logistic regression was used to identify predictors of virologic failure. Results: Of 586 unique patients reviewed, 210 (35.8%) qualified as ‘stable’ for antiretroviral therapy (ART) delivery. There was high utilization of certain HIV service programs (e.g. HIV status disclosure to partners (83%) and treatment ‘buddy’ program participation (62.8%)), while other service programs (e.g. partner testing and community HIV support group participation) had low utilization (<50%). Of 429 patients with available viral load, 277 (64.6%) were virologically suppressed. In the multivariate logistic regression analysis of risk factors of virologic failure, CD4 < 350 cells/mm3 (p = 0.009), atazanavir-based ART (p = 0.032), once monthly versus once two- or three-monthly ART dispensing (p = 0.028), history of ART switching (p = 0.02), poor adherence (p = 0.001) and not having received adherence support (p < 0.001) were independent predictors of virologic failure. Conclusion: Approximately one in three HIV-infected patients on ART were eligible for DSD. We identified gaps in HIV care (i.e. low partner testing, treatment ‘buddy’, program participation and a substantially high rate of virologic failure) that need to be addressed in preparation for full implementation of DSD in Sierra Leone.
KW - HIV
KW - Sierra Leone
KW - differentiated care
KW - implementation
KW - resource-limited settings
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U2 - 10.1080/16549716.2021.1947566
DO - 10.1080/16549716.2021.1947566
M3 - Article
C2 - 34404330
AN - SCOPUS:85113724342
SN - 1654-9716
VL - 14
JO - Global health action
JF - Global health action
IS - 1
M1 - 1947566
ER -