Human immunodeficiency virus care cascade among sub-populations in Rakai, Uganda: an observational study

Veena G. Billioux, Larry Chang, Steven James Reynolds, Gertrude Nakigozi, Joseph Ssekasanvu, Mary Grabowski, Robert Ssekubugu, Fred Nalugoda, Godfrey Kigozi, Joseph Kagaayi, David Serwadda, Ronald H Gray, Maria J Wawer

Research output: Contribution to journalArticle

Abstract

INTRODUCTION: To assess progress towards the UNAIDS 90-90-90 initiative targets, we examined the HIV care cascade in the population-based Rakai Community Cohort Study (RCCS) in rural Uganda and examined differences between sub-groups.

METHODS: Self-reports and clinical records were used to assess the proportion achieving each stage in the cascade. Statistical inference based on a χ2 test for categorical variables and modified Poisson regression were used to estimate prevalence risk ratios (PRRs) and 95% confidence intervals (CI) for enrolment into care and initiating antiretroviral therapy (ART).

RESULTS: From September 2013 through December 2015, 3,666 HIV-positive participants were identified in the RCCS. As of December 2015, 98% had received HIV Counseling and Testing (HCT), 74% were enrolled in HIV care, and 63% had initiated ART of whom 92% were virally suppressed after 12 months on ART. Engagement in care was lower among men than women (enrolment in care: adjPRR 0.84, 95% CI 0.77-0.91; ART initiation: adjPRR 0.75, 95% CI 0.69-0.82), persons aged 15-24 compared to those aged 30-39 (enrolment: adjPRR 0.72, 95% CI 0.63-0.82; ART: adjPRR 0.69, 95%CI 0.60-0.80), unmarried persons (enrolment: adjPRR 0.84, 95% CI 0.71-0.99; ART adjPRR 0.80, 95% CI 0.66-0.95), and new in-migrants (enrolment: adjPRR 0.75, 95% CI 0.67-0.83; ART: adjPRR 0.76, 95% CI 0.67-0.85). This cohort achieved 98-65-92 towards the UNAIDS "90-90-90" targets with an estimated 58% of the entire HIV-positive RCCS population virally suppressed.

CONCLUSIONS: This cohort achieved over 90% in both HCT and viral suppression among ART users, but only 65% in initiating ART, likely due to both an ART eligibility criterion of <500 CD4 cells/mL and suboptimal entry into care among men, younger individuals, and in-migrants. Interventions are needed to promote enrolment in HIV care, particular for hard-to-reach sub-populations.

Original languageEnglish (US)
Number of pages1
JournalJournal of the International AIDS Society
Volume20
Issue number1
DOIs
StatePublished - Jun 5 2017

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Uganda
Observational Studies
HIV
Confidence Intervals
Population
Therapeutics
Cohort Studies
Counseling
Self Report
Odds Ratio

Keywords

  • antiretroviral
  • HIV
  • HIV care cascade
  • Rakai
  • Uganda

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Infectious Diseases

Cite this

Human immunodeficiency virus care cascade among sub-populations in Rakai, Uganda : an observational study. / Billioux, Veena G.; Chang, Larry; Reynolds, Steven James; Nakigozi, Gertrude; Ssekasanvu, Joseph; Grabowski, Mary; Ssekubugu, Robert; Nalugoda, Fred; Kigozi, Godfrey; Kagaayi, Joseph; Serwadda, David; Gray, Ronald H; Wawer, Maria J.

In: Journal of the International AIDS Society, Vol. 20, No. 1, 05.06.2017.

Research output: Contribution to journalArticle

Billioux, Veena G. ; Chang, Larry ; Reynolds, Steven James ; Nakigozi, Gertrude ; Ssekasanvu, Joseph ; Grabowski, Mary ; Ssekubugu, Robert ; Nalugoda, Fred ; Kigozi, Godfrey ; Kagaayi, Joseph ; Serwadda, David ; Gray, Ronald H ; Wawer, Maria J. / Human immunodeficiency virus care cascade among sub-populations in Rakai, Uganda : an observational study. In: Journal of the International AIDS Society. 2017 ; Vol. 20, No. 1.
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T1 - Human immunodeficiency virus care cascade among sub-populations in Rakai, Uganda

T2 - an observational study

AU - Billioux, Veena G.

AU - Chang, Larry

AU - Reynolds, Steven James

AU - Nakigozi, Gertrude

AU - Ssekasanvu, Joseph

AU - Grabowski, Mary

AU - Ssekubugu, Robert

AU - Nalugoda, Fred

AU - Kigozi, Godfrey

AU - Kagaayi, Joseph

AU - Serwadda, David

AU - Gray, Ronald H

AU - Wawer, Maria J

PY - 2017/6/5

Y1 - 2017/6/5

N2 - INTRODUCTION: To assess progress towards the UNAIDS 90-90-90 initiative targets, we examined the HIV care cascade in the population-based Rakai Community Cohort Study (RCCS) in rural Uganda and examined differences between sub-groups.METHODS: Self-reports and clinical records were used to assess the proportion achieving each stage in the cascade. Statistical inference based on a χ2 test for categorical variables and modified Poisson regression were used to estimate prevalence risk ratios (PRRs) and 95% confidence intervals (CI) for enrolment into care and initiating antiretroviral therapy (ART).RESULTS: From September 2013 through December 2015, 3,666 HIV-positive participants were identified in the RCCS. As of December 2015, 98% had received HIV Counseling and Testing (HCT), 74% were enrolled in HIV care, and 63% had initiated ART of whom 92% were virally suppressed after 12 months on ART. Engagement in care was lower among men than women (enrolment in care: adjPRR 0.84, 95% CI 0.77-0.91; ART initiation: adjPRR 0.75, 95% CI 0.69-0.82), persons aged 15-24 compared to those aged 30-39 (enrolment: adjPRR 0.72, 95% CI 0.63-0.82; ART: adjPRR 0.69, 95%CI 0.60-0.80), unmarried persons (enrolment: adjPRR 0.84, 95% CI 0.71-0.99; ART adjPRR 0.80, 95% CI 0.66-0.95), and new in-migrants (enrolment: adjPRR 0.75, 95% CI 0.67-0.83; ART: adjPRR 0.76, 95% CI 0.67-0.85). This cohort achieved 98-65-92 towards the UNAIDS "90-90-90" targets with an estimated 58% of the entire HIV-positive RCCS population virally suppressed.CONCLUSIONS: This cohort achieved over 90% in both HCT and viral suppression among ART users, but only 65% in initiating ART, likely due to both an ART eligibility criterion of <500 CD4 cells/mL and suboptimal entry into care among men, younger individuals, and in-migrants. Interventions are needed to promote enrolment in HIV care, particular for hard-to-reach sub-populations.

AB - INTRODUCTION: To assess progress towards the UNAIDS 90-90-90 initiative targets, we examined the HIV care cascade in the population-based Rakai Community Cohort Study (RCCS) in rural Uganda and examined differences between sub-groups.METHODS: Self-reports and clinical records were used to assess the proportion achieving each stage in the cascade. Statistical inference based on a χ2 test for categorical variables and modified Poisson regression were used to estimate prevalence risk ratios (PRRs) and 95% confidence intervals (CI) for enrolment into care and initiating antiretroviral therapy (ART).RESULTS: From September 2013 through December 2015, 3,666 HIV-positive participants were identified in the RCCS. As of December 2015, 98% had received HIV Counseling and Testing (HCT), 74% were enrolled in HIV care, and 63% had initiated ART of whom 92% were virally suppressed after 12 months on ART. Engagement in care was lower among men than women (enrolment in care: adjPRR 0.84, 95% CI 0.77-0.91; ART initiation: adjPRR 0.75, 95% CI 0.69-0.82), persons aged 15-24 compared to those aged 30-39 (enrolment: adjPRR 0.72, 95% CI 0.63-0.82; ART: adjPRR 0.69, 95%CI 0.60-0.80), unmarried persons (enrolment: adjPRR 0.84, 95% CI 0.71-0.99; ART adjPRR 0.80, 95% CI 0.66-0.95), and new in-migrants (enrolment: adjPRR 0.75, 95% CI 0.67-0.83; ART: adjPRR 0.76, 95% CI 0.67-0.85). This cohort achieved 98-65-92 towards the UNAIDS "90-90-90" targets with an estimated 58% of the entire HIV-positive RCCS population virally suppressed.CONCLUSIONS: This cohort achieved over 90% in both HCT and viral suppression among ART users, but only 65% in initiating ART, likely due to both an ART eligibility criterion of <500 CD4 cells/mL and suboptimal entry into care among men, younger individuals, and in-migrants. Interventions are needed to promote enrolment in HIV care, particular for hard-to-reach sub-populations.

KW - antiretroviral

KW - HIV

KW - HIV care cascade

KW - Rakai

KW - Uganda

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