Factors associated with uptake of home-based HIV counselling and testing and HIV care services among identified HIV-positive persons in Masaka, Uganda

ABSTRACT

We investigated uptake of home-based HIV counselling and testing (HBHCT) and HIV care services post-HBHCT in order to inform the design of future HBHCT programmes. We used data from an open-label cluster-randomised controlled trial which had demonstrated the effectiveness of a post-HBHCT counselling intervention in increasing linkage to HIV care. HBHCT was offered to adults (≥18 years) from 28 rural communities in Masaka, Uganda; consenting HIV-positive care naïve individuals were enrolled and referred for care. The trial's primary outcome was linkage to HIV care (clinic-verified registration for care) six months post-HBHCT. Random effects logistic regression was used to investigate factors associated with HBHCT uptake, linkage to care, CD4 count receipt, and antiretroviral therapy (ART) initiation; all analyses of uptake of post-HBHCT services were adjusted for trial arm allocation. Of 13,455 adults offered HBHCT, 12,100 (89.9%) accepted. HBHCT uptake was higher among men [adjusted odds ratio (aOR) 1.20, 95% confidence interval (CI) = 1.07–1.36] than women, and decreased with increasing age. Of 551 (4.6%) persons who tested HIV-positive, 205 (37.2%) were in care. Of those not in care, 302 (87.3%) were enrolled in the trial and of these, 42.1% linked to care, 35.4% received CD4 counts, and 29.8% initiated ART at 6 months post-HBHCT. None of the investigated factors was associated with linkage to care. CD4 count receipt was lower in individuals who lived ≥30 min from an HIV clinic (aOR 0.60, 95%CI = 0.34–1.06) versus those who lived closer. ART initiation was higher in older individuals (≥45 years versus <25 years, aOR 2.14, 95% CI = 0.98–4.65), and lower in single (aOR 0.60, 95% CI = 0.28–1.31) or divorced/separated/widowed (aOR 0.47, 95% CI = 0.23–0.93) individuals versus those married/cohabiting. HBHCT was highly acceptable but uptake of post-HBHCT care was low. Other than post-HBHCT counselling, this study did not identify specific issues that require addressing to further improve linkage to care.

KEYWORDS:

• HIV/AIDS
• HIV counselling and testing
• linkage to HIV care
• Uganda
• Africa

Acknowledgements

We thank the study participants and the project staff. We acknowledge the support and collaboration of HIV care centres in Masaka, Kalungu, Rakai and Mpigi districts (TASO, Uganda Cares, Masaka Regional Referral Hospital, Villa Maria Hospital, Kitovu Hospital, Kalisizo Hospital, Gombe Hospital, and the health centres of Mpugwe, Kiyumba, Butende, Bukeeri, Buwunga, and Kyanamukaaka).

Disclosure statement

No potential conflict of interest was reported by the authors.

ORCID

Eugene Ruzagira http://orcid.org/0000-0002-7291-1693

Additional information

Funding

This study was jointly funded by the UK Medical Research Council (MRC) and the UK Department for International Development (DFID) under the MRC/DFID Concordat agreement and was also part of the second European and Developing Countries Clinical Trials Partnership programme supported by the European Union. The International AIDS Vaccine Initiative provided funds for HIV test kits. The Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine provided funds to cover CD4 count tests.