HIV Medicine
Volume 18, Issue 7, 2017, Pages 513-518

The cascade of HIV care among refugees and nationals in Nakivale Refugee Settlement in Uganda (Article) (Open Access)

O'Laughlin K.N.* , Kasozi J. , Rabideau D.J. , Parker R.A. , Mulogo E. , Faustin Z.M. , Greenwald K.E. , Doraiswamy S. , Walensky R.P. , Bassett I.V.
  • a Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, United States, Department of Medicine, Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, United States, Harvard Medical School, Boston, MA, United States, Harvard Humanitarian Initiative, Cambridge, MA, United States
  • b Representation in Uganda, United Nations High Commissioner for Refugees, Kampala, Uganda
  • c Massachusetts General Hospital Biostatistics Center, Massachusetts General Hospital, Boston, MA, United States, Harvard University Center for AIDS Research, Boston, MA, United States
  • d Department of Medicine, Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, United States, Harvard Medical School, Boston, MA, United States, Massachusetts General Hospital Biostatistics Center, Massachusetts General Hospital, Boston, MA, United States, Harvard University Center for AIDS Research, Boston, MA, United States, Division of General Medicine, Massachusetts General Hospital, Boston, MA, United States
  • e Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
  • f Kasese Campus, Bugema University, Kampala, Uganda
  • g Harvard Medical School, Boston, MA, United States
  • h United Nations High Commissioner for Refugees, Geneva, Switzerland
  • i Department of Medicine, Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, United States, Harvard Medical School, Boston, MA, United States, Harvard University Center for AIDS Research, Boston, MA, United States, Division of General Medicine, Massachusetts General Hospital, Boston, MA, United States, Division of Infectious Disease, Massachusetts General Hospital, Boston, MA, United States, Division of Infectious Disease, Brigham and Women's Hospital, Boston, MA, United States
  • j Department of Medicine, Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, United States, Harvard Medical School, Boston, MA, United States, Harvard University Center for AIDS Research, Boston, MA, United States, Division of General Medicine, Massachusetts General Hospital, Boston, MA, United States, Division of Infectious Disease, Massachusetts General Hospital, Boston, MA, United States

Abstract

Objectives: Refugees living in Uganda come from HIV-endemic countries, and many remain in refugee settlements for over a decade. Our objective was to evaluate the HIV care cascade in Nakivale Refugee Settlement and to assess correlates of linkage to care. Methods: We prospectively enrolled individuals accessing clinic-based HIV testing in Nakivale Refugee Settlement from March 2013 to July 2014. Newly HIV-diagnosed clients were followed for 3 months post-diagnosis. Clients underwent a baseline survey. The following outcomes were obtained from HIV clinic registers in Nakivale: clinic attendance (‘linkage to HIV care’), CD4 testing, antiretroviral therapy (ART) eligibility, and ART initiation within 90 days of testing. Descriptive data were reported as frequency with 95% confidence interval (CI) or median with interquartile range (IQR). The impact of baseline variables on linkage to care was assessed with logistic regression models. Results: Of 6850 adult clients tested for HIV, 276 (4%; CI: 3–5%) were diagnosed with HIV infection, 148 (54%; CI: 47–60%) of those were linked to HIV care, 54 (20%; CI: 15–25%) had a CD4 test, 22 (8%; CI: 5–12%) were eligible for ART, and 17 (6%; CI: 3–10%) initiated ART. The proportions of refugees and nationals at each step of the cascade were similar. We identified no significant predictors of linkage to care. Conclusions: Less than a quarter of newly HIV-diagnosed clients completed ART assessment, considerably lower than in other reports from sub-Saharan Africa. Understanding which factors hinder linkage to and engagement in care in the settlement will be important to inform interventions specific for this environment. © 2017 British HIV Association

Author Keywords

Sub-Saharan Africa care continuum cascade of care HIV Refugee

Index Keywords

patient care prospective study HIV Infections refugee Human immunodeficiency virus infection Prospective Studies human HIV test Refugees middle aged cd4 antigen priority journal Aged Uganda Young Adult Humans Adolescent health services research male CD4 lymphocyte count female refugee camp Continuity of Patient Care Article health care major clinical study adult antiretroviral therapy anti human immunodeficiency virus agent

Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85010669848&doi=10.1111%2fhiv.12476&partnerID=40&md5=7d81f85b9772bef6ad9390e53b844419

DOI: 10.1111/hiv.12476
ISSN: 14642662
Cited by: 2
Original Language: English