A cohort study to assess a communication intervention to improve linkage to HIV care in Nakivale Refugee Settlement, Uganda

ABSTRACT

Communication interventions to enhance linkage to HIV care have been successful in sub-Saharan Africa but have not been assessed among refugees. Refugees and Ugandan nationals participating in HIV testing in Nakivale Refugee Settlement were offered weekly phone call and short message service (SMS) reminders. We assessed linkage to care and predictors of linkage within 90 days of testing, comparing Intervention participants to those unwilling or ineligible to participate (Non-Intervention). Of 208 individuals diagnosed with HIV, 101 (49%) participated in the intervention. No difference existed between Intervention and Non-intervention groups in linkage to care (73 [72%] vs. 76 [71%], p = 0.88). Excluding those who linked prior to receipt of intervention, the intervention improved linkage (69 [68%] vs. 50 [47%], p = 0.002). Participants were more likely to link if they were older (aOR 2.39 [1.31, 4.37], p = 0.005) or Ugandan nationals (aOR 3.76 [1.12, 12.66], p = 0.033). Although the communication intervention did not significantly improve linkage to HIV care, the linkage was improved when excluding those with same-day linkage. Excluding participants without a phone was a significant limitation; these data are meant to inform more rigorous designs moving forward. Innovative methods to improve linkage to HIV care for this vulnerable population are urgently needed.

KEYWORDS:

• HIV
• linkage to care
• refugees
• mobile phone
• SMS

Disclosure statement

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

Additional information

Funding

This work was supported by the Harvard University Center for AIDS Research [grant number NIH/NIAID 5P30AI060354], the National Institute of Mental Health [grant number K23 MH108440], the Weissman Family MGH Research Scholar Award [grant number K24 AI141036], and the Steve and Deborah Gorlin MGH Research Scholar Award. These funding bodies did not participate in study design, data collection, data analysis, data interpretation, or in writing of this manuscript.