Baseline Characteristics
The total number of participants was 771 of which 42.7% were male and 57.3% were female with the mean age being 40 years (Table 2). The majority (86%) of the participants had been on ART for less than 6 years and the rest were above 6 years. Based on the MUAC 92.2% were well-nourished, 1.4% had moderate acute malnutrition, whereas 6.4% had severe acute malnutrition (Table 4).
Retention rate
In this study, clients who were active by 2017 and maintained an active follow-up throughout the follow-up period of 48 months were considered as retained. Lost to follow up are those clients who missed their appointments by 90 days and thereafter. The cumulative outcomes were; lost to follow-up, 119(15.43%), and active follow-up was 651(84.57%) with a follow-up duration of 48 months. The corresponding retention rates at 95% CI of participants were 12 months (99.35%), 24 months (94.03%), 36 months (89.88%), and at 48months (84.57%). (Figures2 and 3)
Viral load
In this study, a virally suppressed client was defined as a person whose HIV viral load was < 1000 copies/µl of blood. The cumulative outcomes of viral load were; suppressed 532(69%), non-suppressed 53(6.87%), and those without results 186(24.12%). The corresponding viral load suppression rates at 95% CI of participants were 12 months (57.3%,11.9%,33.8% for suppressed, non-suppressed, and those without results respectively),24 months (70.3%, 8.6%, 21.1% for suppressed, non-suppressed and those without results respectively), 36months (70.3%, 8.3%, 20% for suppressed, non-suppressed and those without results respectively) and at 48months (69%, 6.87%, 24.12% for suppressed, non-suppressed and those without results respectively) (Figures 1 and 4)
Determinants of retention and viral load suppression.
Logistic regression analysis was performed to determine what extent has DSDM and other factors contributed to viral suppression and retention among ART clients in Katakwi district.
After adjustment in multivariate analysis, the significant determinants of retention were; age (OR 1.16, 95% CI: 0.89-1.52) current adherence (OR 0.69, 95% CI: 0.27:1.74) current regimen (OR 4.53, 95% CI: 1.07-19.05) DSD model (OR 0.87, 95% CI: 0.76-1.01) comorbidities (OR 0.89, 95% CI: 0.70-1.12) (Table 5).
Multivariate analysis showed that, the significant determinants for viral load suppression were; age (OR 1.12, 95% CI:0.90-1.39), facility level (OR 0.92, 95% CI:0.70-1.21), sex (OR 1.02, 95% CI:0.73-1.43), marital status (OR 0.98, 95% CI:0.82-1.17), current adherence (OR 0.36, 95% CI:0.17-0.77), current regimen (OR 2.19, 95% CI:0.99-4.83) and type of DSD model (OR 0.96, 95% CI:0.87-1.07) (Table 6).
Analysis of missing data
The missing data were treated and analysed as the rest of the data as shown in the tables 2, 3, and 4
TABLE 2: Demographic characteristics of study participants
Variable
|
Retention
|
Viral load suppression
|
Retained(n/%)
|
Lost (n/%)
|
(N/%)
|
Suppressed
(n/%)
|
Non-suppressed
(n/%)
|
Missing
|
(N/%)
|
Age
|
0-19
|
78(11.62)
|
5(5.0)
|
83(10.77)
|
53(9.96)
|
18(33.96)
|
12(6.45)
|
83(10.77)
|
20-39
|
244(36.36)
|
57(57.0)
|
301(39.04)
|
189(35.53)
|
15(28.30)
|
97(52.15)
|
301(39.04)
|
40-59
|
277(41.28)
|
27(27.0)
|
304(39.43)
|
226(42.48)
|
18(33.96)
|
60(32.260
|
304(39.43)
|
60-above 79
|
72(10.73)
|
41.28(11.0)
|
83(10.77)
|
64(12.03)
|
2(3.77)
|
17(9.14)
|
83(10.77)
|
Total
|
671(87)
|
100(13)
|
771(100)
|
532(69)
|
53(6.87)
|
186(24.13)
|
771(100)
|
Sex
|
male
|
295(43.96)
|
34(34)
|
329(42.67)
|
216(40.6)
|
35(66.04)
|
78(41.94)
|
329(42.67)
|
female
|
376(56.04)
|
66(66)
|
442(57.33)
|
316(59.4)
|
18(33.960
|
108(58.06)
|
442(57.33)
|
Total
|
671(87)
|
100(13)
|
771(100)
|
532(69)
|
53(6.87)
|
186(24.13)
|
771(100)
|
Marital status
|
single
|
136(20.270
|
17(17)
|
153(19.84)
|
96(18.05)
|
22(41.51)
|
35(18.82)
|
153(19.84)
|
married
|
426(63.49)
|
59(59)
|
485(62.99)
|
346(65.04)
|
27(50.94)
|
112(60.22)
|
485(62.91)
|
widow
|
28(4.17)
|
7(7)
|
35(4.540
|
26(4.89)
|
0(0)
|
9(4.54)
|
35(4.54)
|
divorced
|
8(1.19)
|
2(2)
|
10(1.3)
|
7(1.37)
|
0(0)
|
3(1.61)
|
10(1.3)
|
Missing results
|
73(10.88)
|
15(15)
|
88(11.41)
|
57(10.71)
|
4(7.55)
|
27(14.52)
|
88(11.41)
|
Total
|
671(87)
|
100(13)
|
771(100)
|
532(69)
|
53(6.87)
|
186(24.13)
|
771(100)
|
facility level
|
HC III
|
276(41.13)
|
40(40)
|
316(40.99)
|
210(39.47)
|
32(60.38)
|
74(39.788)
|
316(40.99)
|
HC IV
|
36(5.37)
|
11(11)
|
47(6.10)
|
30(5.64)
|
1(1.89)
|
16(8.6)
|
47(6.1)
|
General Hospital
|
359(53.50)
|
49(49)
|
408(52.92)
|
292(54.89)
|
20(37.74)
|
96(51.61)
|
408(52.92)
|
Total
|
671(87)
|
100(13)
|
771(100)
|
532(69)
|
53(6.87)
|
186(24.13)
|
771(100)
|
Retention was highest among clients of 20-59 years of age, females, married, and attending in a general hospital, whereas the percentage of viral load suppression was highest among 40-59 years of age, females, married and clients attending in General hospital.
TABLE 3; Baseline characteristics of the study participants
variable
|
|
Retention
|
Viral load suppression
|
|
|
Retained
|
Lost
|
(N/%)
|
Suppressed
|
Non -suppressed
|
missing
|
(N/%)
|
Initial CD4
|
1-200
|
100(14.90)
|
13(13)
|
113(14.66)
|
82(15.41)
|
8(15.09)
|
23(12.37)
|
113(14.66)
|
201-400
|
139(21.02)
|
29(29)
|
168(21.79)
|
120(22.56)
|
6(11.32)
|
42(22.58)
|
168(21.79)
|
401-600
|
95(14.16)
|
11(110)
|
106(13.75)
|
79(14.85)
|
8(15.09)
|
19(10.22)
|
106(13.75)
|
601-800
|
62(9.24)
|
4(4)
|
66(8.56)
|
49(9.21)
|
2(3.77)
|
15(88.06)
|
66(8.56)
|
Above 800
|
59(8.79)
|
11(11)
|
70(9.08)
|
48(9.02)
|
3(5.66)
|
19(10.22)
|
70(9.08)
|
missing
|
216(32.19)
|
32(32)
|
248(32.17)
|
154(28.95)
|
26(49.06)
|
68(36.56)
|
248(32.17)
|
|
Total
|
671(87)
|
100(13)
|
771(100)
|
532(69)
|
53(6.87)
|
186(24.13)
|
771(100)
|
Initial WHO stage
|
1
|
402(59.91)
|
56(56)
|
458(59.40)
|
323(60.71)
|
30(56.60)
|
105(56.45)
|
458(59.40)
|
2
|
193(28.76)
|
31(31.0)
|
224(29.05)
|
148(27.82)
|
18(33.96)
|
58(31.18)
|
224(29.05)
|
3
|
73(10.88)
|
11(11.0)
|
84(10.89)
|
58(10.90)
|
5(9.43)
|
21(11.29)
|
84(10.89)
|
4
|
3(0.45)
|
2(2.0)
|
5(0.65)
|
3(0.56)
|
0(0)
|
2(1.08)
|
5(0.65)
|
|
Total
|
671(87)
|
100(13)
|
771(100)
|
532(69)
|
53(6.87)
|
186(24.13)
|
771(100)
|
Initial regimen
|
first
|
658(98.31)
|
98(98.0)
|
756(9.05)
|
526(98.85)
|
48(90.57)
|
183(98.39)
|
576(98.05)
|
second
|
12(1.79)
|
2(2)
|
14(1.82)
|
6(1.13)
|
5(9.43)
|
3(1.61)
|
14(1.82)
|
|
Total
|
671(87)
|
100(13)
|
771(100)
|
532(69)
|
53(6.87)
|
186(24.13)
|
771(100)
|
Initial adherence
|
good
|
641(95.53)
|
92(92.0)
|
733(955.07)
|
513(96.43)
|
49(92.45)
|
171(91.94)
|
733(98.07)
|
Fair
|
10(1.49)
|
1(1.0)
|
11(1.43)
|
7(1.32)
|
1(1.89)
|
3(1.61)
|
11(1.43)
|
Poor
|
20(2.98)
|
7(7.0)
|
27(3.5)
|
12(2.26)
|
3(5.66)
|
12(6.45)
|
27(3.5)
|
|
Total
|
671(87)
|
100(13)
|
771(100)
|
532(69)
|
53(6.87)
|
186(24.13)
|
771(100)
|
The retention and viral load suppression were highest amongst; Clients with initial CD4 201-400, Initial WHO clinical stage 1, good initial adherence, and clients on first-line regimen.
TABLE 4: Other clinical characteristics of the study participants.
variable
|
|
retention
|
Viral load suppression
|
DSD models
|
|
Retained
|
Lost
|
(N/%)
|
Suppressed
|
Non suppressed
|
missing
|
(N/%)
|
FTDR
|
306(45.60)
|
20(20)
|
326(42.28)
|
264(49.62)
|
10(18.87)
|
52(27.96)
|
326(42.28)
|
FBG
|
69(10.28)
|
7(7)
|
76(9.86)
|
50(9.4)
|
15(28.30)
|
11(5.91)
|
76(9.86)
|
FBIM
|
108(16.01)
|
64(64)
|
172(22.31)
|
59(11.09)
|
26(49.06)
|
87(46.77)
|
172(22.31)
|
CCLAD
|
163(24.29)
|
9(9)
|
172(22.31)
|
136(25.56)
|
2(3.77)
|
34(18.28)
|
172(22.31)
|
CDDP
|
25(3.73)
|
0(0)
|
25(3.24)
|
23(4.32)
|
0(0)
|
2(1.08)
|
25(3.24)
|
|
Total
|
671(87)
|
100(13)
|
771(100)
|
532(69)
|
53(6.87)
|
186(24.13)
|
771(100)
|
Duration on ART (years)
|
0-5
|
524(78.09)
|
85(85.0)
|
609(78.99)
|
407(76.50)
|
44(83.02)
|
158(84.95)
|
608(78.99)
|
6-10
|
134(19.97)
|
14(14)
|
148(19.2)
|
114(21.43)
|
8(15.09)
|
26(13.98)
|
148(19.2)
|
11-15
|
11(1.64)
|
1(1)
|
12(1.56)
|
9(1.69)
|
1(1.89)
|
2(1.08)
|
12(1.56)
|
16 and above
|
2(0.3)
|
0(0)
|
2(0.26)
|
2(0.38)
|
0(0)
|
0(0)
|
2(0.26)
|
|
Total
|
671(87)
|
100(13)
|
771(100)
|
532(69)
|
53(6.87)
|
186(24.13)
|
771(100)
|
comorbidities
|
PTB
|
15(2.24)
|
4(4)
|
19(2.46)
|
10(1.88)
|
5(9.43)
|
4(2.15)
|
19(246)
|
PJP
|
1(0.15)
|
0(0)
|
1(0.13)
|
1(0.19)
|
0(0)
|
0(0)
|
1(0.13)
|
HTN & DM
|
1(0.15)
|
1(1)
|
2(0.26)
|
1(0.19)
|
0(0)
|
1(0.54)
|
2(0.26)
|
malnutrition
|
1(0.15)
|
2(2)
|
3(0.39)
|
1(0.19)
|
0(0)
|
2(1.08)
|
3(0.39)
|
Cry meningitis
|
1(0.15)
|
1(1)
|
2(0.26)
|
0(0)
|
0(0)
|
2(1.08)
|
2(0.26)
|
fungal infection
|
3(0.45)
|
1(1)
|
4(0.52)
|
3(0.56)
|
0(0)
|
1(0.54)
|
4(0.52)
|
other
|
21(3.13)
|
4(4)
|
25(3.24)
|
16(3.01)
|
1(1.89)
|
8(4.30)
|
25(3.24)
|
none
|
628(93.59)
|
87(87)
|
715(92.74)
|
500(93.98)
|
47(88.68)
|
168(90.32)
|
715(92.74)
|
|
Total
|
671(87)
|
100(13)
|
771(100)
|
532(69)
|
53(6.87)
|
186(24.13)
|
771(100)
|
Current regimen
|
first
|
619(92.25)
|
98(98)
|
717(93.0)
|
503(94.55)
|
36(67.92)
|
178(95.7)
|
717(93.0)
|
second
|
52(7.75)
|
2(2)
|
54(7.0)
|
29(5.45)
|
17(32.08)
|
8(4.30)
|
54(7.0)
|
|
Total
|
671(87)
|
100(13)
|
771(100)
|
532(69)
|
53(6.87)
|
186(24.13)
|
771(100)
|
Current adherence
|
good
|
646(96.27)
|
89(89)
|
735(95.33)
|
521(97.93)
|
48(90.57)
|
166(89.25)
|
735(95.33)
|
fair
|
8(1.19)
|
4(4)
|
12(1.56)
|
5(0.94)
|
2(3.77)
|
5(2.69)
|
12(1.56)
|
poor
|
17(2.53)
|
7(7)
|
24(3.11)
|
6(1.13)
|
3(5.66)
|
15(8.06)
|
24(3.11)
|
|
Total
|
671(87)
|
100(13)
|
771(100)
|
532(69)
|
53(6.87)
|
186(24.13)
|
771(100)
|
WHO clinical stage
|
1
|
596(88.96)
|
85(85.86)
|
681(88.56)
|
487(91.71)
|
38(71.70)
|
156(84.32)
|
681(88.56)
|
2
|
68(10.15)
|
12(12.12)
|
80(10.40)
|
40(7.53)
|
13(24.53)
|
27(14.59)
|
80(1040)
|
3
|
6(0.90)
|
2(2.02)
|
8(1.04)
|
4(0.75)
|
2(3.77)
|
2(1.08)
|
8(1.04)
|
|
Total
|
671(87)
|
100(13)
|
771(100)
|
532(69)
|
53(6.87)
|
186(24.13)
|
771(100)
|
The majority of the clients were in FTDR however performance in both retention and Viral Load suppression were highest in CDDP. Retention and viral load suppression were highest among the following groups; 0-5 years of age, first-line regimen, good adherence, and stage 1 WHO staging and PTB was the commonest comorbidity.
TABLE 5: Determinants of retention to care
retention
|
Odds Ratio
|
P-value
|
[95% Conf. Interval]
|
age
|
1.163117
|
0.001
|
0.888887-1.521949
|
Current adherence
|
0.6868554
|
0.005
|
0.27021-1.74594
|
Current regimen
|
4.528328
|
0.036
|
1.076053-19.05645
|
Type of DSD model
|
0.875006
|
0.001
|
0.758093-1.00995
|
comorbidities
|
0.8875778
|
0.037
|
0.70142-1.123142
|
TABLE 6: Determinants of viral load suppression.
Viral load suppression
|
Odds Ratio
|
P-value
|
[95% Conf. Interval]
|
Age
|
1.120251
|
0.001
|
0.903982-1.388262
|
Facility level
|
0.9221916
|
0.020
|
0.700178-1.214602
|
sex
|
1.022738
|
0.002
|
0.729055-1.434725
|
Marital status
|
0.9788787
|
0.007
|
0.817738-1.171773
|
Current adherence
|
0.3587538
|
0.001
|
0.166869-0.771289
|
Current regimen
|
2.189893
|
0.001
|
0.992561-4.831575
|
Type of DSD model
|
0.9656563
|
0.001
|
0.867439-1.074995
|
Retention of ART clients was highest in 2017 and reduced overtime was lowest in 2020
Clients in CDDP had the highest percentage of Viral Load suppression whereas FBIM had the lowest.
The percentage of clients having their Viral load suppressed increased over time being highest in 2019.
The percentage of clients with suppressed viral load was highest in CDDP and lowest in FBIM