Marseille 2007
| Abstract #419 - Adherence to ART and Integration of HIV Prevention into AIDS care: An Operations Research Study of Various ART Delivery Models in Uganda | ||||
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Session: 24.4: Adherence (Parallel) on Monday @ 16.30-18.30 in HC Chaired by Ana Josefina Guell, Rahul Battcharya Authors: Presenting Author: Dr Wilford Kirungi - Ministry of Health, Uganda |
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| Additional Authors: Dr Elizabeth Madraa, Dr Norah Namuwenge, Dr Frank Lule, Dr Elizabeth Namagala, Dr Abdikamil Alisalad, | ||||
| Aim: Of the approximately one million people living with HIV in Uganda, about 200,000 are clinically eligible for Anti Retroviral Therapy (ART), but scarce resources and poor infrastructure constrain universal access to ART. In 2004, a plan for scaling up ART in Uganda was started, and to-date, about 88,000 people are receiving treatment. Various ART programmes were started by different stakeholders in order to rapidly scale up ART provision; however, they were based on different modes of ART delivery. This study explored the extent to which the various modes of ART delivery address treatment adherence and integration of HIV prevention in order to inform the ART scale up plan. The specific objectives were to: i) describe and document the different modes of ART service delivery operating in Uganda ii) determine the levels of ART adherence and HIV prevention behaviour among clients in various ART programmes iii) identify what adherence support mechanisms and HIV prevention strategies exist in different ART programmes and iv) identify factors affecting ART adherence and integration of HIV prevention into AIDS care. | ||||
| Method / Issue: Through a cross sectional situational analysis, trained field workers collected data from about 2,000 exit ART clients and 400 providers in 82 facilities providing ART services in various parts of the country based on different ART delivery modes. Clinical records were reviewed for data on biological and physiological measures including CD-4 T cell counts, body weight, clinical stage etc. ART adherence was assessed based on the three day self-recall and the 30 day visual analog methods. HIV prevention was assessed based on clients knowledge of HIV prevention, their recent sexual behaviour and health workers provision of information and HIV prevention services. This study analyses data from these sites in order to establish levels of adherence, patterns of sexual behaviour and patterns of disclosure of HIV status and how they differ across different ART programmes. | ||||
| Results / Comments: Overall, ART adherence was high and most programmes were integrating HIV prevention into AIDS care. However, the levels of ART adherence and integration of HIV prevention and factors associated with them varied across ART service delivery modes. About three-quarters of ART clients were currently sexually active, however, the patterns of preventive and high risk sexual behaviour i.e. condom use, having multiple partners, disclosure of HIV status to partners, knowledge of partners HIV status and sexual relations with partners of unknown status varied across ART service delivery modes. ART adherence and integration of HIV prevention practices appeared to correlate with the social support that clients receive, clients lifestyle, workload of providers and whether ART service delivery is within a context of a holistic programme. | ||||
| Discussion: These findings highlight the importance of ART service delivery as part of a holistic package and have implications for the scale up of ART in Uganda. The factors associated with ART adherence and uptake of preventive sexual behaviour by ART clients require further examination perhaps through an experimental design. | ||||
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