Ainembabazi Bridget, Katana Elizabeth, Bongomin Felix, Wanduru Phillip, Mayega Roy William, Mukose Aggrey David
Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.
College of Health Sciences, Makerere University, Kampala, Uganda.
Ther Adv Infect Dis. 2024 May 19;11:20499361241251936. doi: 10.1177/20499361241251936. eCollection 2024 Jan-Dec.
Despite adoption of the 'test-and-treat' strategy, a high proportion of antiretroviral therapy (ART) naïve people living with HIV (PLHIV) enrol in care with, and die of advanced HIV disease (AHD) in Uganda. In this study, we aimed to determine the prevalence of AHD among ART naïve adults enrolling in care and associated factors at selected public health facilities in Kampala, Uganda.
From April to July 2022, we conducted a mixed-methods study at Kiswa Health Centre III, Kitebi Health Centre III, and Kawaala Health Centre IV. The study involved cross-sectional enrolment and evaluation of 581 participants, utilizing an interviewer-administered questionnaire and chart reviews. Modified Poisson regression was employed to identify factors associated with AHD, complemented by a qualitative component comprising fifteen in-depth interviews, with data analysed through thematic analysis.
Overall, 35.1% (204/581) of the study participants had AHD. Being male [adjusted prevalence ratio (aPR): 1.4, 95% CI: 1.04-1.88] and aged 35-50 years (aPR: 1.81, 95% CI: 1.14-2.88) were associated with AHD. Participants with no personal health perception barriers had 37% lower odds of presenting to care with AHD (aPR: 0.63, 95% CI: 0.46-0.85). Qualitative findings indicated that individual factors, such as waiting until physical health deteriorated and initially opting for alternative therapies, took precedence in contributing to enrolment in care with AHD.
Over one in every three ART naïve adults presents to public health facilities in Uganda with AHD. Male gender, age 35-50 years, and personal health perception barriers emerged as significant factors associated with AHD; emphasizing the need for targeted interventions to address these disparities and enhance early detection and engagement in care. Routine HIV testing should be emphasized and incentivized especially for men and persons aged 35-50 years.
尽管采用了“检测即治疗”策略，但在乌干达，很大一部分未接受过抗逆转录病毒治疗（ART）的艾滋病毒感染者（PLHIV）在接受治疗时已处于晚期艾滋病毒疾病（AHD）阶段并最终死亡。在本研究中，我们旨在确定乌干达坎帕拉选定公共卫生设施中未接受过ART治疗的成年就诊者中AHD的患病率及其相关因素。
2022年4月至7月，我们在基斯瓦健康中心三级、基特比健康中心三级和卡瓦拉健康中心四级开展了一项混合方法研究。该研究包括对581名参与者进行横断面登记和评估，采用访谈式问卷和病历审查。采用修正泊松回归来确定与AHD相关的因素，并辅以由15次深入访谈组成的定性部分，通过主题分析对数据进行分析。
总体而言，35.1%（204/581）的研究参与者患有AHD。男性[调整患病率比（aPR）：1.4，95%置信区间（CI）：1.04 - 1.88]和年龄在35至50岁之间（aPR：1.81，95% CI：1.14 - 2.88）与AHD相关。没有个人健康认知障碍的参与者因AHD就诊的几率降低37%（aPR：0.63，95% CI：0.46 - 0.85）。定性研究结果表明，个人因素，如等到身体健康恶化以及最初选择替代疗法，在导致因AHD就诊方面占主导地位。
在乌干达，每三名未接受过ART治疗的成年人中就有超过一人因AHD前往公共卫生设施就诊。男性、年龄35至50岁以及个人健康认知障碍是与AHD相关的重要因素；这凸显了需要采取针对性干预措施来解决这些差异，并加强早期检测和治疗参与度。应强调并激励进行常规艾滋病毒检测，尤其是针对男性和35至50岁的人群。
