Improving linkage to treatment and retention in care among people living with HIV in Uganda

Although there has been tremendous progress in HIV testing and treatment access in sub-Saharan Africa and worldwide, linkage to treatment and retention in care for people living with HIV remains a challenge in many settings. Pediatric and adolescent patients tend to be especially high-risk for dropping out of care or never starting treatment after being diagnosed with the disease. More evidence is needed on cost-effective and sustainable strategies to keep individuals in care once they have been diagnosed.

In Uganda, CHAI worked with the Ministry of Health to implement a proactive follow-up intervention in 20 facilities. The intervention included training and empowerment of healthcare workers in best practices for patient follow-up including better recordkeeping processes, phone calls and home visits for patients who missed appointments, and enhanced patient counseling about the disease. To understand whether the intervention worked, the team compared patient data before and after program rollout and conducted focus groups and interviews with patients and staff to understand program successes and challenges.

After nine months, patient adherence to appointments and retention in HIV care increased significantly, even while gaps in linkage to treatment for HIV positive individuals remained. Of great importance, the improvements in retention in care were more dramatic for pediatric and adolescent patients, the group most prone to falling through the cracks. Despite some challenges, facility staff and patients felt strongly that the program was effective and should continue. The study team concluded that improving patient tracking and counseling practices was relatively low-cost and promoted patient retention in care, particularly for vulnerable children and adolescents.

Read more about the findings from this study in this Evidence Brief as well as in peer-reviewed publications in BMC Infectious Diseases (preliminary findings) and BMC Health Services Research (results of the intervention study).