15
www.ias2013.org Kuala Lumpur, Malaysia , 30 June - 3 July 20 Outcomes of newly diagnosed HIV-infected patients referred to care after Provider Initiated HIV Counseling and Testing (PITC) in Uganda July 1 st 2013 Dalsone Kwarisiima MD, MPH F Semitala, J Ngabirwe, N Matsiko, S Muhumuza, J Namusobya, C Nawavvu and M R. Kamya Makerere University Joint AIDS Program

Dalsone Kwarisiima MD, MPH

  • Upload
    anja

  • View
    40

  • Download
    0

Embed Size (px)

DESCRIPTION

Outcomes of newly diagnosed HIV-infected patients referred to care after Provider Initiated HIV Counseling and Testing (PITC) in Uganda July 1 st 2013. Dalsone Kwarisiima MD, MPH F Semitala, J Ngabirwe, N Matsiko, S Muhumuza, J Namusobya, C Nawavvu and M R. Kamya - PowerPoint PPT Presentation

Citation preview

Page 1: Dalsone Kwarisiima MD, MPH

www.ias2013.org Kuala Lumpur, Malaysia , 30 June - 3 July 2013

Outcomes of newly diagnosed HIV-infected patients referred to care after Provider Initiated HIV Counseling and Testing (PITC) in Uganda

July 1st 2013

Dalsone Kwarisiima MD, MPH

F Semitala, J Ngabirwe, N Matsiko, S Muhumuza, J Namusobya, C Nawavvu and M R. Kamya

Makerere University Joint AIDS Program

Page 2: Dalsone Kwarisiima MD, MPH

www.ias2013.org Kuala Lumpur, Malaysia , 30 June - 3 July 2013

Background

Successful HIV care requires; -early identification of HIV infected individuals -immediate linkage to care - long-term retention on potent ART Less than 60% are assessed for ART eligibility

within 3 months following a positive HIV test1

1Rosen , 2011

Page 3: Dalsone Kwarisiima MD, MPH

www.ias2013.org Kuala Lumpur, Malaysia , 30 June - 3 July 2013

Click icon to add picture

Page 4: Dalsone Kwarisiima MD, MPH

www.ias2013.org Kuala Lumpur, Malaysia , 30 June - 3 July 2013

Background continued

MJAP has provided PITC in large national referral and teaching hospitals since 2004

Identified HIV-infected patients are referred to clinics of their choice

Outcome of referrals of newly diagnosed HIV-infected patients is largely unknown

Page 5: Dalsone Kwarisiima MD, MPH

www.ias2013.org Kuala Lumpur, Malaysia , 30 June - 3 July 2013

Objectives

Evaluate outcomes of referral of HIV-infected Patients identified through PITC

Evaluate access to CD4 testing and ART among patients linked to care.

Page 6: Dalsone Kwarisiima MD, MPH

www.ias2013.org Kuala Lumpur, Malaysia , 30 June - 3 July 2013

Methods We reviewed PITC registers between Nov 2011 and March 2012 A total of 19,794 patients received PITC

2327 were HIV-infected 867 were randomly selected

We interviewed the selected on phone For unsuccessful initial phone call, two more attempts were made We collected data on :

– Patient’s vital status – Social demographics – Dates of HIV test and enrollment into HIV care – Reasons for non-linkage– Access to baseline CD4 testing – Access to ART

Used logistic regression to analyze for predictors of linkage

Dr Moses Kamya
Dr Moses Kamya
Page 7: Dalsone Kwarisiima MD, MPH

www.ias2013.org Kuala Lumpur, Malaysia , 30 June - 3 July 2013

Results

We ascertained outcomes for 70% (620/867) of interviewed

Successfully completed the calls for 81% (500/620)

Majority were females (55%) Mean age was 31 years (SD,9.4)

Dr Moses Kamya
What is successful completion of a phone call?
Page 8: Dalsone Kwarisiima MD, MPH

www.ias2013.org Kuala Lumpur, Malaysia , 30 June - 3 July 2013

Outcomes of phone contacts made n=867

Dr Moses Kamya
I thought this N should be 620??
Page 9: Dalsone Kwarisiima MD, MPH

www.ias2013.org Kuala Lumpur, Malaysia , 30 June - 3 July 2013

Out comes of referralsN= 500

Linked to care 91%, (454/500)

Not linked 9%, (46/500)

Median time from diagnosis to linkage was 3 months, (IQR=2 - 5)

Page 10: Dalsone Kwarisiima MD, MPH

www.ias2013.org Kuala Lumpur, Malaysia , 30 June - 3 July 2013

Reasons for Non-linkage n=46

Page 11: Dalsone Kwarisiima MD, MPH

www.ias2013.org Kuala Lumpur, Malaysia , 30 June - 3 July 2013

Factors associated with Linkage to HIV care

Predictor/Factor

Linked to Care Odds P-value CI

Yes No

Sex

Male 194 18 1.000

Female 260 28 0.861 0.638 0.463 - 1.602Age group <30 177 26 1.000 ≥30 277 20 2.034 0.023 1.102 - 3.754

Education level

Primary and below

163 131.000

Secondary 219 26 0.672 0.263 0.335 - 1.347 Tertiary 72 7 0.820 0.686 0.314 - 2.142

Marital Status

Single 81 16 1.000 Windowed 59 4 2.914 0.067 0.926 - 9.164Divorced 57 1 11.259 0.021 1.452 - 87.33Married 257 25 2.031 0.040 1.034 - 3.990

Dr Moses Kamya
Widowed and divorced women are also single.
Page 12: Dalsone Kwarisiima MD, MPH

www.ias2013.org Kuala Lumpur, Malaysia , 30 June - 3 July 2013

Access to CD4 testing and ART

CD4 Testing(n=500) Had a CD4 done = 441(88%) Had Not yet had CD4 done = 19(4%) Not sure if CD4 was done = 40(8%)

ART(n=500) On ART = 275(60%) Not on ART=181(39%) Unknown=5(1%)

Page 13: Dalsone Kwarisiima MD, MPH

www.ias2013.org Kuala Lumpur, Malaysia , 30 June - 3 July 2013

Limitations

Recall bias A third of patients could not be reached, so

their outcomes could not be ascertained Our findings on linkage at a large national

referral hospital may have limited generalizability.

Page 14: Dalsone Kwarisiima MD, MPH

www.ias2013.org Kuala Lumpur, Malaysia , 30 June - 3 July 2013

Conclusion

Majority of the patients successfully tracked were in care

Outcomes a third of newly diagnosed HIV patients was not ascertained

Being single and younger age were predictors of not being in care

Need to design Strategies for active linkage and follow up of identified HIV positive

Page 15: Dalsone Kwarisiima MD, MPH

www.ias2013.org Kuala Lumpur, Malaysia , 30 June - 3 July 2013

Acknowledgement

HIV patients who participated MJAP PITC team Mulago Hospital Staff PEPFAR and CDC