Factors Associated with Linkage to HIV Care Among Oral Self-Tested HIV Positive Adults in Uganda

Abstract

Background

HIV oral self-testing (HIVST) was rolled out in Uganda in 2018. However, data reported by public facilities show that less than 60% of oral self-tested HIV positive adults were linked to HIV care. This study set out to determine the factors associated with linkage to HIV care among adults with positive HIV oral self-test results in Uganda.

Methods

A cross-sectional study was carried out at Nabweru HCIII and Entebbe Hospital in central Uganda. The study reviewed medical records from January 2019 to May 2020 and successfully invited 144 self-tested HIV positive participants for the quantitative interview process. Data on socio-demographics and health-related characteristics were collected. Bivariate and multivariable analysis was used to determine the factors associated with linkage to care.

Results

The proportion of participants linked to HIV care was 69.6% (100/144). The majority of the participants were female (71%), with a mean age of 29 (±8) years. Participants within age groups of 31–35 years and 41–60 years, who used directly assisted HIVST, disclosed their HIV status to their sexual partners, are ready to start ART, do not consume alcohol and having a supportive sexual partner were more likely to be linked to HIV care. Single participants, separated/divorced, female, fear unfair treatment after HIV status disclosure and those who fear ART side effects were less likely to be linked to HIV care.

Conclusion

Our study showed that less than 70% were linked to HIV care. It also shows that HIV status disclosure, readiness to start ART, type of HIVST used, fear of ART side effects, and being divorced/separated negatively associated with linkage to HIV care among self-test HIV positive adults. There is a need for HIV programs to address the above factors to improve linkage to HIV care to realize the national targets towards the UNAIDs 2035 goals.

Keywords:

• linkage to HIV care
• HIV oral self-testing
• Uganda

Abbreviations

APRR, adjusted prevalence rate ratio; ART, antiretroviral therapy; HIV/AIDS, human immunodeficiency virus/acquired immune deficiency syndrome; HIVST, HIV self-testing; HTC, HIV testing and counselling; HTS, HIV testing services; PRR, prevalence rate ratio; MOH, Ministry of Health Uganda; PLHIV, people Living with HIV; WHO, World Health Organisation; UNAIDS, Joint United Nations Programme on HIV/AIDS; UPHIA, Uganda Population-Based HIV Impact Assessment survey; MSM, men who have sex with men; FSW, female sex workers; PMTCT, prevention of mother to child transmission.

Data Sharing Statement

Materials and data analyzed during this study can be made available to all interested researchers upon reasonable request directed to the corresponding author, Mr Bbuye Mudarshiru on email; [email protected].

Ethical Approval and Consent

Ethics approval for this study was obtained from the Makerere University School of Public Health Higher Degrees and the Ethics review committee. Administrative clearance was obtained from the Ministry of Health Uganda and the health facilities.

Written informed consent was obtained from the participants before attending interviews. Confidentiality of participants’ information was ensured through coding unique identifiers for each participant. Interviews were conducted in a private setting identified in consultation with the participants. All participants who had not been linked to HIV care were counselled by the health facility counsellors and encouraged to start HIV treatment. This study complied with the Helsinki declaration.

Acknowledgments

We thank the study participants for their time and for agreeing to participate in the study. We acknowledge the health facility staff who assisted in data collection and the health-facility in-charges of the different health facilities. We acknowledge the implementing partners at health facilities including Mildmay, Uganda Cares, and Serving Lives Under Marginalisation (SLUM)-Community-based organization, Nabweru Uganda.

Author Contributions

All authors made substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; took part in drafting the article or revising it critically for important intellectual content; agreed to submit to the current journal; gave final approval of the version to be published; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare that they have no conflicts of interest for this work.

Additional information

Funding

This research reported was supported by the Fogarty International Centre of the National Institutes of Health, US Department of State’s Office of the US Global AIDS Coordinator and Health Diplomacy (S/GAC), and President’s Emergency Plan for AIDS Relief (PEPFAR) under Award Number 1R25TW011213. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.