TY - JOUR
T1 - Incidence of Health Facility Switching and Associations With HIV Viral Rebound Among Persons on Antiretroviral Therapy in Uganda
T2 - A Population-based Study
AU - Rosen, Greg
AU - Ndyanabo, Anthony
AU - Nakawooya, Hadijja
AU - Galiwango, Ronald M.
AU - Ssekubugu, Robert
AU - Ssekasanvu, Joseph
AU - Kim, Seungwon
AU - Rucinski, Katherine B.
AU - Nakigozi, Gertrude
AU - Nalugoda, Fred
AU - Kigozi, Godfrey
AU - Quinn, Thomas C
AU - Chang, Larry W.
AU - Kennedy, Caitlin E.
AU - Reynolds, Steven James
AU - Kagaayi, Joseph
AU - Grabowski, M. Kate
N1 - Publisher Copyright:
© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved.
PY - 2024/6/15
Y1 - 2024/6/15
N2 - Background. A substantial proportion of persons on antiretroviral therapy (ART) considered lost to follow-up have actually transferred their human immunodeficiency virus (HIV) care to other facilities. However, the relationship between facility switching and virologic outcomes, including viral rebound, is poorly understood. Methods. We used data from 40 communities (2015–2020) in the Rakai Community Cohort Study to estimate incidence of facility switching and viral rebound. Persons aged 15–49 years with serologically confirmed HIV who self-reported ART use and contributed ≥1 follow-up visit were included. Facility switching and virologic outcomes were assessed between 2 consecutive study visits (ie, index and follow-up visits, interval of approximately 18 months). Those who reported different HIV treatment facilities between index and follow-up study visits were classified as having switched facilities. Virologic outcomes included viral rebound among individuals initially suppressed (<200 copies/mL). Multivariable Poisson regression was used to estimate associations between facility switching and viral rebound. Results. Overall, 2257 persons who self-reported ART use (median age, 35 years; 65% female, 92% initially suppressed) contributed 3335 visit-pairs and 5959 person-years to the analysis. Facility switching was common (4.8 per 100 person-years; 95% confidence interval [CI], 4.2–5.5) and most pronounced in persons aged <30 years and fishing community residents. Among persons suppressed at their index visit (n = 2076), incidence of viral rebound was more than twice as high in persons who switched facilities (adjusted incidence rate ratio = 2.27; 95% CI, 1.16–4.45). Conclusions. Facility switching was common and associated with viral rebound among persons initially suppressed. Investments in more agile, person-centered models for mobile clients are needed to address system inefficiencies and bottlenecks that can disrupt HIV care continuity.
AB - Background. A substantial proportion of persons on antiretroviral therapy (ART) considered lost to follow-up have actually transferred their human immunodeficiency virus (HIV) care to other facilities. However, the relationship between facility switching and virologic outcomes, including viral rebound, is poorly understood. Methods. We used data from 40 communities (2015–2020) in the Rakai Community Cohort Study to estimate incidence of facility switching and viral rebound. Persons aged 15–49 years with serologically confirmed HIV who self-reported ART use and contributed ≥1 follow-up visit were included. Facility switching and virologic outcomes were assessed between 2 consecutive study visits (ie, index and follow-up visits, interval of approximately 18 months). Those who reported different HIV treatment facilities between index and follow-up study visits were classified as having switched facilities. Virologic outcomes included viral rebound among individuals initially suppressed (<200 copies/mL). Multivariable Poisson regression was used to estimate associations between facility switching and viral rebound. Results. Overall, 2257 persons who self-reported ART use (median age, 35 years; 65% female, 92% initially suppressed) contributed 3335 visit-pairs and 5959 person-years to the analysis. Facility switching was common (4.8 per 100 person-years; 95% confidence interval [CI], 4.2–5.5) and most pronounced in persons aged <30 years and fishing community residents. Among persons suppressed at their index visit (n = 2076), incidence of viral rebound was more than twice as high in persons who switched facilities (adjusted incidence rate ratio = 2.27; 95% CI, 1.16–4.45). Conclusions. Facility switching was common and associated with viral rebound among persons initially suppressed. Investments in more agile, person-centered models for mobile clients are needed to address system inefficiencies and bottlenecks that can disrupt HIV care continuity.
KW - HIV treatment
KW - HIV viremia
KW - clinic transfers
KW - sub-Saharan Africa
KW - viral load suppression
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U2 - 10.1093/cid/ciad773
DO - 10.1093/cid/ciad773
M3 - Article
C2 - 38114162
AN - SCOPUS:85196230511
SN - 1058-4838
VL - 78
SP - 1591
EP - 1600
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 6
ER -