Evaluating facility-based antiretroviral therapy programme effectiveness: a pilot study comparing viral load...

Area of Science:

• Public Health
• Infectious Diseases
• HIV/AIDS Research

Background:

• Antiretroviral therapy (ART) programs face increasing demand and stagnant funding, necessitating robust effectiveness monitoring.
• Evaluating ART program success requires assessing both patient retention and viral load (VL) suppression.

Purpose of the Study:

• To compare patient retention metrics with viral load suppression rates at 15 health facilities in Uganda.
• To determine the correlation between 12- and 24-month retention rates and facility-level viral load suppression in ART programs.

Main Methods:

• Retrospective chart review to estimate 12- and 24-month retention rates.
• HIV RNA VL testing for adult patients on ART for at least six months.
• Multilevel logistic regression to model VL suppression and retention, estimating facility effects.

Main Results:

• 88% of 2961 patients achieved viral load suppression (VL ≤1000 copies/ml), with facility rates ranging from 77% to 96%.
• Facility performance varied significantly even after controlling for patient mix.
• 12-month retention was 91% and 24-month retention was 79%, with comparable facility-level variation.
• Neither 12-month (ρ = 0.16) nor 24-month (ρ = -0.19) retention rates correlated with facility viral load suppression rates.

Conclusions:

• Both patient retention and viral load suppression are critical outcomes in ART programs.
• The lack of correlation between retention and viral load suppression highlights the need for VL monitoring to accurately assess facility effectiveness.
• Viral load monitoring is crucial for a comprehensive evaluation of ART service delivery.