Assessing eligibility for differentiated service delivery, HIV services utilization and virologic outcomes of adult HIV-infected patients in Sierra Leone: a pre-implementation analysis

ABSTRACT

Background

There are limited data to help guide implementation of differentiated HIV service delivery (DSD) in resource-limited settings in sub-Saharan Africa.

Objectives

This pre-implementation study sought to assess the proportion of patients eligible for DSD and HIV services utilization, as well as risk factor analysis of virologic failure in Sierra Leone.

Methods

We conducted a retrospective study of adult HIV-infected patients aged 18 years and older receiving care at the largest HIV treatment center in Sierra Leone 2019–2020. Multiple logistic regression was used to identify predictors of virologic failure.

Results

Of 586 unique patients reviewed, 210 (35.8%) qualified as ‘stable’ for antiretroviral therapy (ART) delivery. There was high utilization of certain HIV service programs (e.g. HIV status disclosure to partners (83%) and treatment ‘buddy’ program participation (62.8%)), while other service programs (e.g. partner testing and community HIV support group participation) had low utilization (<50%). Of 429 patients with available viral load, 277 (64.6%) were virologically suppressed. In the multivariate logistic regression analysis of risk factors of virologic failure, CD4 < 350 cells/mm³ (p = 0.009), atazanavir-based ART (p = 0.032), once monthly versus once two- or three-monthly ART dispensing (p = 0.028), history of ART switching (p = 0.02), poor adherence (p = 0.001) and not having received adherence support (p < 0.001) were independent predictors of virologic failure.

Conclusion

Approximately one in three HIV-infected patients on ART were eligible for DSD. We identified gaps in HIV care (i.e. low partner testing, treatment ‘buddy’, program participation and a substantially high rate of virologic failure) that need to be addressed in preparation for full implementation of DSD in Sierra Leone.

KEYWORDS:

• HIV
• differentiated care
• implementation
• resource-limited settings
• Sierra Leone

Responsible Editor

Stig Wall

Responsible Editor

Stig Wall

Acknowledgments

We wish to thank the HIV Clinic staff at Connaught Hospital in Freetown, Sierra Leone for their dedication to patient care.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Ethics and consent

Ethics approval was obtained from the Sierra Leone Ethics Scientific and Research Committee. Clinical data were de-identified, therefore written informed consent was not required for this retrospective study.

Paper context

There are limited data to help guide implementation of differentiated HIV service delivery (DSD) in Sierra Leone and other countries in sub-Saharan Africa. This pre-implementation analysis found that about one-third of HIV patients on ART were eligible for DSD. We identified gaps in HIV care (i.e. low partner testing, treatment ‘buddy’, program participation and significant proportion of patients with virologic failure) that need to be addressed in preparation for full implementation of DSD in Sierra Leone.

Additional information

Funding

GAY was supported by the Roe Green Travel Medicine and Global Health Award 2019, University Hospitals Cleveland Medical Center (Award Number J0628);Roe Green Travel Medicine Award 2019 [J0628].

Notes on contributors

George A. Yendewa

SL: Study design, data collection, statistical analysis, result interpretation, manuscript writing

DFJ, AOV: Study design, data collection, manuscript writing

EP, OA, GFD, FS, CJH, JMJ, RAS: Result interpretation, manuscript writing

GAY: Study design, funding acquisition, statistical analysis, result interpretation, manuscript writing.