Factors influencing initiation into antiretroviral therapy of HIV-positive clients at HIV testing service outreaches in Wakiso district.

Abstract

Introduction Despite tremendous gains in HIV treatment, accessibility and scale-up, initiation into care among patients who test HIV positive remains low. Recent research (MOH, 2017; Andrew, 2017) estimated that, Uganda had only about 64% of the 1.3 million HIV positive clients enrolled into ART. At this rate of enrollment, it is unlikely that the country will attain the 90-90-90 UNAID target by 2020. In Wakiso district, Uganda AIDS Commission (2016) estimated 570 girls and young women aged 15 to 24 were getting infected with HIV every week, without statistics of the incidence rates in the general district population, whose prevalence among the 2,007,700 population is at 10.6% (UBOS, 2017). This study was conducted to understand ART initiation levels in outreaches where factors associated with ART initiation were to be determined. Methodology The study was cross-sectional that employed quantitative and qualitative methods of data collection and analysis, data was analyzed using STATA. Binary logistic regression analysis was also used to come up with the model with use of both crude and adjusted odds ratio to clearly deduce the actual conclusion, this was selected since ART initiation (dependent variable) had two outcomes of yes and No, where No was coded=0 and yes=1. Binary Logistic regression identified whether the factors were significant or not on the dependent variable. During the analysis all the 3 of data analysis types where employed; Multivariate analysis (use of Binary logistic regression), bivariate analysis (use of cross tabulations) and univariate analysis were all applied. The sample was purposively selected from the various outreaches among clients who tested positive Results This study interviewed 135 HIV positive patients from the outreaches, of which 91.8%(124/135) were initiated on ART immediately following the test and treat guidelines, with a p-value of 0.2975, individual characteristics of respondents were not statistically significant at effecting ART initiation, health facility factors did also not directly affect ART initiation with a p-value of 0.1673, as well as social-cultural factors which had no significant effect on ART initiation among the respondents with a p-value of 0.6906. In comparison with district ART initiation levels in the period of April-June 2019, the district non-initiation level was at 8% Conclusions and recommendations Wakiso district has high levels of ART initiation because of the test and treat policy which was introduced by Ministry of Health. However, MOH, Health facilities, district leadership and all stake holders should ensure that people are sensitized routinely on HIV and ART initiation, to bring HIV Testing Services (HTS) nearer to the people, reduce on the long waiting time spent by clients, provide HTS in relation to other services especially those that prevent them from contracting HIV virus like condoms, screening and treatment for STI to ensure that the 90-90-90 UNAIDS targets are achieved by 2030 as well as encouraging cultural and religious leaders to embrace the UNAIDS targets.