Conference abstract

Factors affecting quality of care for virologically non-suppressed HIV positive patients in Jinja, Buikwe and Iganga Districts, Uganda, 2016

Pan African Medical Journal - Conference Proceedings. 2017:6(4).20 Dec 2017.
doi: 10.11604/pamj-cp.2017.6.4.486

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Keywords: Quality of care, HIV positive patients, Uganda

Factors affecting quality of care for virologically non-suppressed HIV positive patients in Jinja, Buikwe and Iganga Districts, Uganda, 2016

Lilian Bulage1,&, Isaac Sewanyana2, Joseph Matovu3, Christine Kihembo1, Fred Nsubuga1, Gerald Pande1, Alex Riolexus Ario1, Charles Kiyaga2, Victoria Nankabirwa3

1Uganda Public Health Fellowship Program, Kampala, Uganda, 2Central Public Health Laboratories, Kampala, Uganda, 3Makerere University School of Public Health, Kampala, Uganda

&Corresponding author
Lilian Bulage, Uganda Public Health Fellowship Program, Kampala, Uganda


Introduction: viral load (VL) testing improves monitoring of patients’ response to HIV therapy. According to the World Health Organization (WHO), more than 70% of non-suppressed clients should re-suppress after 6 months intensified adherence support (IAS). However, only 50% re-suppressed on the 2nd time testing at 6 months of follow up. We established whether virologically non-suppressed patients underwent IAS for 6 months, identified structural and process issues affecting service delivery for non-suppressed clients, estimated outcomes at the end of 6 months period of IAS, and assessed patient and provider perspectives on what else is needed for effective provision of IAS.

Methods: we used the Donabedian model of quality of health care that evaluates structures, processes and outcomes of health care for data collection. We extracted data from clients’ files, ART card, CD4 and VL daily activity register. We interviewed clients who had received their 1st VL results between August 2014 and December 2015 (427) at 10 health facilities. We interviewed ART clinic in-charges, expert clients and laboratory staff (33). In addition, we used checklists and observation guide to obtain additional data. Primary outcome variable was % virological suppression at 6 months and secondary outcomes were % that underwent IAS, % that submitted 6 months follow up sample and % of eligible clients switched to 2nd line ART.

Results: of the 282 clients interviewed, 20% (57/282) had high, 28% (79/282) moderate, and 48% (139/282) low knowledge about VL and VL testing services. Of the 378 clients, only 39% (137/378) underwent IAS for the recommended 6 months, 28% (106/378) 4 - 5 times, 17% (63/378) 1-3 times and 16% (59/378) not conducted, and 1% (3/378) LTFU/Died. 42% (162/379) did not submit FU sample at 6 months, 43% (90/207 tested successfully) non-suppressed on 2nd time testing, 62% (56/90 non-suppressed) not switched to 2nd line, 38% (13/34) switched immediately after 1st VL result, and 56% (65/117) of suppressed clients had been switched immediately after 1st VL result. 14/31 health workers (HW) did not know standard results turn around time (TAT). Clients dislikes about VL testing services were, that knowing VL results causes: stress, worry, scares, discourages and increases stigma. Health workers disliked IAC being recommended without counselors at health facilities, IAS period is short, misallocation of results and VL testing services being very far from clients. Some of the reasons for not switching clients were, clients were given second chance on IAS, the patient feels well, the patient is unreliably adherent to the 1st line therapy and the patient is concerned with the 2nd line therapy side effects.

Conclusion: non-adherence to guidelines for monitoring response to ART using VL and limited knowledge about VL among both non-suppressed clients and health workers was observed. We recommended that the AIDs Control Programme and CPHL come up with performance indicators for monitoring response using VL. The info gathered in this study could guide formulation of clients’ IEC materials.