Top

Published in:

Open Access 01-12-2021 | Care | Research article

Retention in HIV care and associated factors among youths aged 15–24 years in rural southwestern Uganda

Authors: Moses Muwanguzi, Henry Mark Lugobe, Elastus Ssemwanga, Allan Phillip Lule, Elizabeth Atwiine, Vincent Kirabira, Ann K. Stella, Scholastic Ashaba, Godfrey Zari Rukundo

Published in: BMC Public Health | Issue 1/2021

Abstract

Background

Retention in HIV care contributes to antiretroviral therapy adherence, which is a key factor for improved treatment outcomes and prevention of drug resistance. However, HIV treatment among the youths is characterized by loss to follow up, poor adherence to ART, risk of treatment failure and high mortality rates compared to young children and adults. There is limited information about factors associated with retention of youths in HIV care in rural settings in Uganda. We aimed to determine retention in HIV care and associated factors among youths aged 15–24 years in rural southwestern Uganda.

Methods

A cross-sectional study was conducted among youths aged 15–24 years who were receiving care at the HIV clinic at Kabuyanda HC IV who had been in care for at least 1 year before the study. We used an interviewer-administered questionnaire to collect socio-demographic information. Participant chart abstraction was used to collect information on HIV clinic attendance. We collected information on HIV related stigma using the 40-item Berger Stigma Scale. Chi-square test and multivariable logistic regression analysis were used to determine the factors associated with retention in HIV care with a significance level of < 0.05. Retention in HIV care was, defined as having sought care at least once per quarter in the 12 months prior to the study.

Results

We enrolled 102 participants with a mean age of 20.95 (SD ± 3.07) years. Two thirds (65.7%) of the youths had been retained in HIV care in the previous 12 months. In adjusted analyses, being male, married and had perinatally acquired HIV were independently associated with retention in HIV care. The association between HIV related stigma and retention in HIV care was not statistically significant.

Conclusion

Retaining adolescents and young adults in HIV care in rural southwestern Uganda is still much lower than the WHO target of 90%. Being male, having perinatally acquired HIV and married or in a relationship are associated with retention in HIV care. Interventions targeting adolescents and young adults living with HIV are necessary to improve retention in HIV care to the WHO target of 90%.

Available only for authorised users

Vithalani J, Herreros-Villanueva M. HIV epidemiology in Uganda: survey based on age, gender, number of sexual partners and frequency of testing. Afr Health Sci. 2018;18(3):523–30. https://doi.org/10.4314/ahs.v18i3.8.CrossRefPubMedPubMedCentral

Stricker SM, Fox KA, Baggaley R, Negussie E, de Pee S, Grede N, et al. Retention in care and adherence to ART are critical elements of HIV care interventions. AIDS Behav. 2014;18(Suppl 5):S465–75.CrossRef

Kempf MC, McLeod J, Boehme AK, Walcott MW, Wright L, Seal P, et al. A qualitative study of the barriers and facilitators to retention-in-care among HIV-positive women in the rural southeastern United States: implications for targeted interventions. AIDS Patient Care STDs. 2010;24(8):515–20. https://doi.org/10.1089/apc.2010.0065.CrossRefPubMed

Farmer C, Yehia BR, Fleishman JA, Rutstein R, Mathews WC, Nijhawan A, et al. Factors associated with retention among non-perinatally HIV-infected youth in the HIV research network. J Pediatric Infect Dis Soc. 2016;5(1):39–46. https://doi.org/10.1093/jpids/piu102.CrossRefPubMed

Janssen S, Wieten RW, Stolp S, Cremers AL, Rossatanga EG, Klipstein-Grobusch K, et al. Factors associated with retention to care in an HIV clinic in Gabon, Central Africa. PLoS One. 2015;10(10):e0140746. https://doi.org/10.1371/journal.pone.0140746.CrossRefPubMedPubMedCentral

Eduardo E, Lamb MR, Kandula S, Howard A, Mugisha V, Kimanga D, et al. Characteristics and outcomes among older HIV-positive adults enrolled in HIV programs in four sub-Saharan African countries. PLoS One. 2014;9(7):e103864. https://doi.org/10.1371/journal.pone.0103864.CrossRefPubMedPubMedCentral

Lamb MR, Fayorsey R, Nuwagaba-Biribonwoha H, Viola V, Mutabazi V, Alwar T, et al. High attrition before and after ART initiation among youth (15-24 years of age) enrolled in HIV care. AIDS. 2014;28(4):559–68. https://doi.org/10.1097/QAD.0000000000000054.CrossRefPubMed

Zanoni BC, Mayer KH. The adolescent and young adult HIV cascade of care in the United States: exaggerated health disparities. AIDS Patient Care STDs. 2014;28(3):128–35. https://doi.org/10.1089/apc.2013.0345.CrossRefPubMedPubMedCentral

Geng EH, Bangsberg DR, Musinguzi N, Emenyonu N, Bwana MB, Yiannoutsos CT, et al. Understanding reasons for and outcomes of patients lost to follow-up in antiretroviral therapy programs in Africa through a sampling-based approach. J Acquir Immune Defic Syndr. 2010;53(3):405–11. https://doi.org/10.1097/QAI.0b013e3181b843f0.CrossRefPubMedPubMedCentral

10.

Izudi J, Mugenyi J, Mugabekazi M, Muwanika B, Tumukunde Spector V, Katawera A, et al. Retention of HIV-positive adolescents in care: a quality improvement intervention in mid-western Uganda. Biomed Res Int. 2018;2018:1–8. https://doi.org/10.1155/2018/1524016.CrossRef

11.

Atuyambe LM, Ssegujja E, Ssali S, Tumwine C, Nekesa N, Nannungi A, et al. HIV/AIDS status disclosure increases support, behavioural change and, HIV prevention in the long term: a case for an Urban Clinic, Kampala, Uganda. BMC Health Serv Res. 2014;14:276.CrossRef

12.

Kakkar F, Van der Linden D, Valois S, Maurice F, Onnorouille M, Lapointe N, et al. Health outcomes and the transition experience of HIV-infected adolescents after transfer to adult care in Quebec, Canada. BMC Pediatr. 2016;16(1):109. https://doi.org/10.1186/s12887-016-0644-4.CrossRefPubMedPubMedCentral

13.

Auld AF, Agolory SG, Shiraishi RW, Wabwire-Mangen F, Kwesigabo G, Mulenga M, et al. Antiretroviral therapy enrollment characteristics and outcomes among HIV-infected adolescents and young adults compared with older adults—seven African countries, 2004–2013. MMWR Morb Mortal Wkly Rep. 2014;63(47):1097–103.PubMedPubMedCentral

14.

UNAIDS. Global AIDS update 2018. State of the epidemic. Geneva: UNAIDS; 2018. p. 376.

15.

Azia IN, Mukumbang FC, van Wyk B. Barriers to adherence to antiretroviral treatment in a regional hospital in Vredenburg, Western cape, South Africa. South Afr J HIV Med. 2016;17(1):476. https://doi.org/10.4102/sajhivmed.v17i1.476.CrossRefPubMedPubMedCentral

16.

MacDonell K, Naar-King S, Huszti H, Belzer M. Barriers to medication adherence in behaviorally and perinatally infected youth living with HIV. AIDS Behav. 2013;17(1):86–93. https://doi.org/10.1007/s10461-012-0364-1.CrossRefPubMedPubMedCentral

17.

Kenneth Mugisha AO, Semafumu E, Ciccio L, Muwanika RF, Otim J, Makumbi M. Retention of HIV positive persons in antiretroviral therapy programs in post-conflict northern uganda-baseline survey of 17 health units; 2009.

18.

Mesic A, Halim N, MacLeod W, Haker C, Mwansa M, Biemba G. Facilitators and barriers to adherence to antiretroviral therapy and retention in care among adolescents living with HIV/AIDS in Zambia: a mixed methods study. AIDS Behav. 2019;23(9):2618–28. https://doi.org/10.1007/s10461-019-02533-5.CrossRefPubMed

19.

Uganda Bureau of Statistics. The National Population and Housing Census 2014- Main Report, Kampala, Uganda; 2016.

20.

Berger BE, Ferrans CE, Lashley FR. Measuring stigma in people with HIV: psychometric assessment of the HIV stigma scale. Res Nurs Health. 2001;24(6):518–29. https://doi.org/10.1002/nur.10011.CrossRefPubMed

21.

Charles B, Jeyaseelan L, Pandian AK, Sam AE, Thenmozhi M, Jayaseelan V. Association between stigma, depression and quality of life of people living with HIV/AIDS (PLHA) in South India - a community based cross sectional study. BMC Public Health. 2012;12(1):463. https://doi.org/10.1186/1471-2458-12-463.CrossRefPubMedPubMedCentral

22.

Okoboi S, Ssali L, Yansaneh AI, Bakanda C, Birungi J, Nantume S, et al. Factors associated with long-term antiretroviral therapy attrition among adolescents in rural Uganda: a retrospective study. J Int AIDS Soc. 2016;19(5 Suppl 4):20841. https://doi.org/10.7448/IAS.19.5.20841.CrossRefPubMedPubMedCentral

23.

Nabukeera-Barungi N, Elyanu P, Asire B, Katureebe C, Lukabwe I, Namusoke E, et al. Adherence to antiretroviral therapy and retention in care for adolescents living with HIV from 10 districts in Uganda. BMC Infect Dis. 2015;15(1):520. https://doi.org/10.1186/s12879-015-1265-5.CrossRefPubMedPubMedCentral

24.

Brown LB, Ayieko J, Mwangwa F, Owaraganise A, Kwarisiima D, Jain V, et al. Predictors of retention in HIV care among youth (15-24) in a universal test-and-treat setting in rural Kenya. J Acquir Immune Defic Syndr. 2017;76(1):e15–e8. https://doi.org/10.1097/QAI.0000000000001390.CrossRefPubMedPubMedCentral

25.

Umeokonkwo CD, Onoka CA, Agu PA, Ossai EN, Balogun MS, Ogbonnaya LU. Retention in care and adherence to HIV and AIDS treatment in Anambra state Nigeria. BMC Infect Dis. 2019;19(1):654. https://doi.org/10.1186/s12879-019-4293-8.CrossRefPubMedPubMedCentral

26.

Santos VF, Pedrosa SC, Aquino PS, Lima ICV, Cunha GH, Galvão MTG. Social support of people with HIV/AIDS: the social determinants of health model. Rev Bras Enferm. 2018;71(suppl 1):625–30. https://doi.org/10.1590/0034-7167-2017-0346.CrossRefPubMed

27.

Foster C, Ayers S, McDonald S, Frize G, Chhabra S, Pasvol TJ, et al. Clinical outcomes post transition to adult services in young adults with perinatally acquired HIV infection: mortality, retention in care and viral suppression. AIDS. 2020;34(2):261–6. https://doi.org/10.1097/QAD.0000000000002410.CrossRefPubMed

28.

Ritchwood TD, Malo V, Jones C, Metzger IW, Atujuna M, Marcus R, et al. Healthcare retention and clinical outcomes among adolescents living with HIV after transition from pediatric to adult care: a systematic review. BMC Public Health. 2020;20(1):1195. https://doi.org/10.1186/s12889-020-09312-1.CrossRefPubMedPubMedCentral

29.

Katusiime C, Schlech WF 3rd, Parkes-Ratanshi R, Sempa J, Kambugu A. Characteristics of sexually transmitted infections among high-risk HIV-positive patients attending an urban clinic in Uganda. J Int Assoc Provid AIDS Care. 2016;15(1):36–41. https://doi.org/10.1177/2325957413506493.CrossRefPubMed

30.

Valverde E, Rodriguez A, White B, Guo Y, Waldrop-Valverde D. Understanding the Association of Internalized HIV Stigma with retention in HIV Care. J HIV AIDS. 2018;4(3). https://doi.org/10.16966/2380-5536.159.

31.

Ochieng-Ooko V, Ochieng D, Sidle JE, Holdsworth M, Wools-Kaloustian K, Siika AM, et al. Influence of gender on loss to follow-up in a large HIV treatment programme in western Kenya. Bull World Health Organ. 2010;88(9):681–8. https://doi.org/10.2471/BLT.09.064329.CrossRefPubMedPubMedCentral

32.

Kebede HK, Mwanri L, Ward P, Gesesew HA. Predictors of lost to follow up from antiretroviral therapy among adults in sub-Saharan Africa: a systematic review and meta-analysis. Infect Dis Poverty. 2021;10(1):33. https://doi.org/10.1186/s40249-021-00822-7.CrossRefPubMedPubMedCentral

33.

Koech E, Teasdale CA, Wang C, Fayorsey R, Alwar T, Mukui IN, et al. Characteristics and outcomes of HIV-infected youth and young adolescents enrolled in HIV care in Kenya. AIDS. 2014;28(18):2729–38. https://doi.org/10.1097/QAD.0000000000000473.CrossRefPubMed

34.

Triulzi I, Palla I, Ciccacci F, Orlando S, Palombi L, Turchetti G. The effectiveness of interventions to involve men living with HIV positive pregnant women in low-income countries: a systematic review of the literature. BMC Health Serv Res. 2019;19(1):943. https://doi.org/10.1186/s12913-019-4689-6.CrossRefPubMedPubMedCentral

35.

Muwanguzi PA, Nassuna LK, Voss JG, Kigozi J, Muganzi A, Ngabirano TD, et al. Towards a definition of male partner involvement in the prevention of mother-to-child transmission of HIV in Uganda: a pragmatic grounded theory approach. BMC Health Serv Res. 2019;19(1):557. https://doi.org/10.1186/s12913-019-4401-x.CrossRefPubMedPubMedCentral

36.

McCoy K, Lipira L, Kemp CG, Nevin PE, Huh D, Turan JM, et al. Exploring HIV-related stigma as a determinant of engagement in HIV care by African American women. J Assoc Nurses AIDS Care. 2020;31(2):167–75. https://doi.org/10.1097/JNC.0000000000000140.CrossRefPubMedPubMedCentral

37.

Traeger L, O’cleirigh C, Skeer MR, Mayer KH, Safren SA. Risk factors for missed HIV primary care visits among men who have sex with men. J Behav Med. 2012;35(5):548–56. https://doi.org/10.1007/s10865-011-9383-z.CrossRefPubMed

38.

Wohl AR, Galvan FH, Myers HF, Garland W, George S, Witt M, et al. Do social support, stress, disclosure and stigma influence retention in HIV care for Latino and African American men who have sex with men and women? AIDS Behav. 2011;15(6):1098–110. https://doi.org/10.1007/s10461-010-9833-6.CrossRefPubMed

39.

Christopoulos KA, Neilands TB, Hartogensis W, Geng EH, Sauceda J, Mugavero MJ, et al. Internalized HIV stigma is associated with concurrent viremia and poor retention in a cohort of US patients in HIV care. J Acquir Immune Defic Syndr (1999). 2019;82(2):116.CrossRef

40.

Logie CH, Lacombe-Duncan A, Wang Y, Kaida A, Conway T, Webster K, et al. Pathways from HIV-related stigma to antiretroviral therapy measures in the HIV care cascade for women living with HIV in Canada. J Acquir Immune Defic Syndr (1999). 2018;77(2):144.CrossRef

41.

Pantelic M, Casale M, Cluver L, Toska E, Moshabela M. Multiple forms of discrimination and internalized stigma compromise retention in HIV care among adolescents: findings from a south African cohort. J Int AIDS Soc. 2020;23(5):e25488. https://doi.org/10.1002/jia2.25488.CrossRefPubMedPubMedCentral

42.

Rice WS, Burnham K, Mugavero MJ, Raper JL, Atkins GC, Turan B. Association between internalized HIV-related stigma and HIV care visit adherence. J Acquir Immune Defic Syndr (1999). 2017;76(5):482.CrossRef

43.

Valenzuela C, Ugarte-Gil C, Paz J, Echevarria J, Gotuzzo E, Vermund SH, et al. HIV stigma as a barrier to retention in HIV care at a general hospital in Lima, Peru: a case–control study. AIDS Behav. 2015;19(2):235–45. https://doi.org/10.1007/s10461-014-0908-7.CrossRefPubMedPubMedCentral

44.

Yehia BR, Stewart L, Momplaisir F, Mody A, Holtzman CW, Jacobs LM, et al. Barriers and facilitators to patient retention in HIV care. BMC Infect Dis. 2015;15(1):1–10.CrossRef

45.

Tomori C, Kennedy CE, Brahmbhatt H, Wagman JA, Mbwambo JK, Likindikoki S, et al. Barriers and facilitators of retention in HIV care and treatment services in Iringa, Tanzania: the importance of socioeconomic and sociocultural factors. AIDS Care. 2014;26(7):907–13. https://doi.org/10.1080/09540121.2013.861574.CrossRefPubMed

Title: Retention in HIV care and associated factors among youths aged 15–24 years in rural southwestern Uganda
Authors: Moses Muwanguzi
Henry Mark Lugobe
Elastus Ssemwanga
Allan Phillip Lule
Elizabeth Atwiine
Vincent Kirabira
Ann K. Stella
Scholastic Ashaba
Godfrey Zari Rukundo
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Care
Human Immunodeficiency Virus
Published in: BMC Public Health / Issue 1/2021
Electronic ISSN: 1471-2458
DOI: https://doi.org/10.1186/s12889-021-11547-5

At a glance: The STEP trials

Springer Medicine

Retention in HIV care and associated factors among youths aged 15–24 years in rural southwestern Uganda

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2021

Quality of web-based information at the beginning of a global pandemic: a cross-sectional infodemiology study investigating preventive measures and self care methods of the coronavirus disease 2019

Study protocol: behaviour change intervention to promote healthy diet and physical activity in overweight/obese adults with diabetes attending health care facilities in Muscat: a cluster rendomised control trial

Does substance use by family members and community affect the substance use among adolescent boys? Evidence from UDAYA study, India

Strategies to reengage patients lost to follow up in HIV care in high income countries, a scoping review

Perspectives on voluntary assisted partner notification among providers, people with HIV and the general population in Indonesia: a formative qualitative study

The Body Confident Mums challenge: a feasibility trial and qualitative evaluation of a body acceptance program delivered to mothers using Facebook