Effect and implementation experience of intensive adherence counseling in a public HIV care center in Uganda: a mixed-methods study

Abstract Background Intensive adherence counseling (IAC) is an intervention recommended by the World Health Organization to improve anti-retroviral therapy (ART) adherence among people living with HIV on ART with unsuppressed viral load; and in 2016, the intervention was implemented in Uganda. This...

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Autores principales:	Zubair Lukyamuzi, Samuel Etajak, Thomas Katairo, David Mukunya, Moses Tetui, Aloysius Ssenyonjo, Rhoda K. Wanyenze
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Intensive adherence counseling People living with HIV Unsuppressed viral load Public HIV care center Uganda Infectious and parasitic diseases RC109-216
Acceso en línea:	https://doaj.org/article/1608d602dda94d22ae129a9d014395f9
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spelling	oai:doaj.org-article:1608d602dda94d22ae129a9d014395f92021-11-21T12:42:46ZEffect and implementation experience of intensive adherence counseling in a public HIV care center in Uganda: a mixed-methods study10.1186/s12879-021-06862-61471-2334https://doaj.org/article/1608d602dda94d22ae129a9d014395f92021-11-01T00:00:00Zhttps://doi.org/10.1186/s12879-021-06862-6https://doaj.org/toc/1471-2334Abstract Background Intensive adherence counseling (IAC) is an intervention recommended by the World Health Organization to improve anti-retroviral therapy (ART) adherence among people living with HIV on ART with unsuppressed viral load; and in 2016, the intervention was implemented in Uganda. This study evaluated the effect and experiences of providing IAC in an urban HIV care center in Kampala, Uganda. Methods This was a sequential explanatory mixed-method study that compared viral load suppression during IAC implementation (intervention) to the period before IAC at Kisenyi Health centre IV. Data were abstracted from patient files and viral load register. The effect of IAC on viral load suppression and associated factors were analyzed using modified Poisson regression with robust standard errors. Using in-depth interviews and an inductive analysis approach in Atlas-ti 8. We also explored experiences of providing IAC among healthcare workers. Results A total of 500 records were sampled: 249 (49.8%) in the intervention period and 251 (51.2%) in the pre-intervention period. The mean age was lower during the intervention period 33.1 (± 12.0) than 36.5 (± 13.4) in the pre- intervention period, p = 0.002. More clients were currently on Protease-based regimen in the pre-intervention period 179 (71.3%) than 135 (54.2%) in the intervention period, p ≤ 0.001. In the intervention period, all eligible clients received IAC [249/249 (100.0%)]. Overall, 325 (65.0%) received IAC and of these, 143 (44.1%) achieved viral load suppression compared to 46 (26.3%) who received regular counseling. Receiving IAC significantly increased viral load suppression by 22% (aPR 1.22, 95% CI 1.01–1.47). Clients on Protease-based regimen were less likely to suppress than those on Efavirenz or Nevirapine-based regimens (aPR 0.11, 95% CI 0.08–0.15). All the interviewed healthcare workers lauded IAC for improving ART adherence. However, patient and health care system related factors hindered adherence during IAC. Conclusions The full potential of IAC in achieving viral load suppression in this setting has not been reached due to a combination of the patient and health care system related factors. Provision of adequate IAC necessities and use of patient centered approach should be emphasized to obtain the maximum benefit of the intervention.Zubair LukyamuziSamuel EtajakThomas KatairoDavid MukunyaMoses TetuiAloysius SsenyonjoRhoda K. WanyenzeBMCarticleIntensive adherence counselingPeople living with HIVUnsuppressed viral loadPublic HIV care centerUgandaInfectious and parasitic diseasesRC109-216ENBMC Infectious Diseases, Vol 21, Iss 1, Pp 1-15 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Intensive adherence counseling People living with HIV Unsuppressed viral load Public HIV care center Uganda Infectious and parasitic diseases RC109-216
spellingShingle	Intensive adherence counseling People living with HIV Unsuppressed viral load Public HIV care center Uganda Infectious and parasitic diseases RC109-216 Zubair Lukyamuzi Samuel Etajak Thomas Katairo David Mukunya Moses Tetui Aloysius Ssenyonjo Rhoda K. Wanyenze Effect and implementation experience of intensive adherence counseling in a public HIV care center in Uganda: a mixed-methods study
description	Abstract Background Intensive adherence counseling (IAC) is an intervention recommended by the World Health Organization to improve anti-retroviral therapy (ART) adherence among people living with HIV on ART with unsuppressed viral load; and in 2016, the intervention was implemented in Uganda. This study evaluated the effect and experiences of providing IAC in an urban HIV care center in Kampala, Uganda. Methods This was a sequential explanatory mixed-method study that compared viral load suppression during IAC implementation (intervention) to the period before IAC at Kisenyi Health centre IV. Data were abstracted from patient files and viral load register. The effect of IAC on viral load suppression and associated factors were analyzed using modified Poisson regression with robust standard errors. Using in-depth interviews and an inductive analysis approach in Atlas-ti 8. We also explored experiences of providing IAC among healthcare workers. Results A total of 500 records were sampled: 249 (49.8%) in the intervention period and 251 (51.2%) in the pre-intervention period. The mean age was lower during the intervention period 33.1 (± 12.0) than 36.5 (± 13.4) in the pre- intervention period, p = 0.002. More clients were currently on Protease-based regimen in the pre-intervention period 179 (71.3%) than 135 (54.2%) in the intervention period, p ≤ 0.001. In the intervention period, all eligible clients received IAC [249/249 (100.0%)]. Overall, 325 (65.0%) received IAC and of these, 143 (44.1%) achieved viral load suppression compared to 46 (26.3%) who received regular counseling. Receiving IAC significantly increased viral load suppression by 22% (aPR 1.22, 95% CI 1.01–1.47). Clients on Protease-based regimen were less likely to suppress than those on Efavirenz or Nevirapine-based regimens (aPR 0.11, 95% CI 0.08–0.15). All the interviewed healthcare workers lauded IAC for improving ART adherence. However, patient and health care system related factors hindered adherence during IAC. Conclusions The full potential of IAC in achieving viral load suppression in this setting has not been reached due to a combination of the patient and health care system related factors. Provision of adequate IAC necessities and use of patient centered approach should be emphasized to obtain the maximum benefit of the intervention.
format	article
author	Zubair Lukyamuzi Samuel Etajak Thomas Katairo David Mukunya Moses Tetui Aloysius Ssenyonjo Rhoda K. Wanyenze
author_facet	Zubair Lukyamuzi Samuel Etajak Thomas Katairo David Mukunya Moses Tetui Aloysius Ssenyonjo Rhoda K. Wanyenze
author_sort	Zubair Lukyamuzi
title	Effect and implementation experience of intensive adherence counseling in a public HIV care center in Uganda: a mixed-methods study
title_short	Effect and implementation experience of intensive adherence counseling in a public HIV care center in Uganda: a mixed-methods study
title_full	Effect and implementation experience of intensive adherence counseling in a public HIV care center in Uganda: a mixed-methods study
title_fullStr	Effect and implementation experience of intensive adherence counseling in a public HIV care center in Uganda: a mixed-methods study
title_full_unstemmed	Effect and implementation experience of intensive adherence counseling in a public HIV care center in Uganda: a mixed-methods study
title_sort	effect and implementation experience of intensive adherence counseling in a public hiv care center in uganda: a mixed-methods study
publisher	BMC
publishDate	2021
url	https://doaj.org/article/1608d602dda94d22ae129a9d014395f9
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Effect and implementation experience of intensive adherence counseling in a public HIV care center in Uganda: a mixed-methods study

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