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www.ias2013.org Kuala Lumpur, Malaysia , 30 June - 3 July 2013
Outcomes of newly diagnosed HIV-infected patients referred to care after Provider Initiated HIV Counseling and Testing (PITC) in Uganda
July 1st 2013
Dalsone Kwarisiima MD, MPH
F Semitala, J Ngabirwe, N Matsiko, S Muhumuza, J Namusobya, C Nawavvu and M R. Kamya
Makerere University Joint AIDS Program
www.ias2013.org Kuala Lumpur, Malaysia , 30 June - 3 July 2013
Background
Successful HIV care requires; -early identification of HIV infected individuals -immediate linkage to care - long-term retention on potent ART Less than 60% are assessed for ART eligibility
within 3 months following a positive HIV test1
1Rosen , 2011
www.ias2013.org Kuala Lumpur, Malaysia , 30 June - 3 July 2013
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www.ias2013.org Kuala Lumpur, Malaysia , 30 June - 3 July 2013
Background continued
MJAP has provided PITC in large national referral and teaching hospitals since 2004
Identified HIV-infected patients are referred to clinics of their choice
Outcome of referrals of newly diagnosed HIV-infected patients is largely unknown
www.ias2013.org Kuala Lumpur, Malaysia , 30 June - 3 July 2013
Objectives
Evaluate outcomes of referral of HIV-infected Patients identified through PITC
Evaluate access to CD4 testing and ART among patients linked to care.
www.ias2013.org Kuala Lumpur, Malaysia , 30 June - 3 July 2013
Methods We reviewed PITC registers between Nov 2011 and March 2012 A total of 19,794 patients received PITC
2327 were HIV-infected 867 were randomly selected
We interviewed the selected on phone For unsuccessful initial phone call, two more attempts were made We collected data on :
– Patient’s vital status – Social demographics – Dates of HIV test and enrollment into HIV care – Reasons for non-linkage– Access to baseline CD4 testing – Access to ART
Used logistic regression to analyze for predictors of linkage
www.ias2013.org Kuala Lumpur, Malaysia , 30 June - 3 July 2013
Results
We ascertained outcomes for 70% (620/867) of interviewed
Successfully completed the calls for 81% (500/620)
Majority were females (55%) Mean age was 31 years (SD,9.4)
www.ias2013.org Kuala Lumpur, Malaysia , 30 June - 3 July 2013
Outcomes of phone contacts made n=867
www.ias2013.org Kuala Lumpur, Malaysia , 30 June - 3 July 2013
Out comes of referralsN= 500
Linked to care 91%, (454/500)
Not linked 9%, (46/500)
Median time from diagnosis to linkage was 3 months, (IQR=2 - 5)
www.ias2013.org Kuala Lumpur, Malaysia , 30 June - 3 July 2013
Reasons for Non-linkage n=46
www.ias2013.org Kuala Lumpur, Malaysia , 30 June - 3 July 2013
Factors associated with Linkage to HIV care
Predictor/Factor
Linked to Care Odds P-value CI
Yes No
Sex
Male 194 18 1.000
Female 260 28 0.861 0.638 0.463 - 1.602
Age group <30 177 26 1.000 ≥30 277 20 2.034 0.023 1.102 - 3.754
Education level
Primary and below
163 131.000
Secondary 219 26 0.672 0.263 0.335 - 1.347 Tertiary 72 7 0.820 0.686 0.314 - 2.142
Marital Status
Single 81 16 1.000 Windowed 59 4 2.914 0.067 0.926 - 9.164Divorced 57 1 11.259 0.021 1.452 - 87.33Married 257 25 2.031 0.040 1.034 - 3.990
www.ias2013.org Kuala Lumpur, Malaysia , 30 June - 3 July 2013
Access to CD4 testing and ART
CD4 Testing(n=500) Had a CD4 done = 441(88%) Had Not yet had CD4 done = 19(4%) Not sure if CD4 was done = 40(8%)
ART(n=500) On ART = 275(60%) Not on ART=181(39%) Unknown=5(1%)
www.ias2013.org Kuala Lumpur, Malaysia , 30 June - 3 July 2013
Limitations
Recall bias A third of patients could not be reached, so
their outcomes could not be ascertained Our findings on linkage at a large national
referral hospital may have limited generalizability.
www.ias2013.org Kuala Lumpur, Malaysia , 30 June - 3 July 2013
Conclusion
Majority of the patients successfully tracked were in care
Outcomes a third of newly diagnosed HIV patients was not ascertained
Being single and younger age were predictors of not being in care
Need to design Strategies for active linkage and follow up of identified HIV positive
www.ias2013.org Kuala Lumpur, Malaysia , 30 June - 3 July 2013
Acknowledgement
HIV patients who participated MJAP PITC team Mulago Hospital Staff PEPFAR and CDC