Viral suppression and continued participation in the Community Retail Pharmacy Drug Distribution Point model among people living with HIV in Uganda.

BACKGROUND

Approximately 1.3 million people living with the HIV (PLHIV) receive antiretroviral treatment (ART) from health facilities in Uganda. The Uganda Ministry of Health (MoH) introduced the Community Retail Pharmacy Drug Distribution Points (CRPDDP) to decongest health facilities, improve efficiency, convenience and patient-centered care while maintaining service quality. This study examined continued model participation and viral load suppression among PLHIV enrolled in CRPDDP for at least one year at Iganga District Hospital, Uganda.

METHODS

This was a retrospective cohort study conducted from January to March 2024 using a census approach. Records of 360 PLHIV enrolled in the CRPPDP model between October 2021 and December 2022 were reviewed. The period was chosen to account for the rolling enrollment. Inclusion required at least 12 months since enrollment by the time of the study, regardless of whether clients remained in the model. Continued participation in the model, viral load at enrollment, latest viral load (at study time), and associated factors were assessed using a log-binomial regression analysis with robust standard errors at a 5% significance.

RESULTS

The mean age of the participants was 43.5 (± 9.8) years, most participants were female (62.2%) and married (53.9%). The continued participation in the model was 94.7% (95% CI: 91.9-96.8). The mean viral suppression while in the model was 96.3 copies/mL (95% CI: 43.3-149.4) compared to 63.2 copies/mL (95% CI: 56.3-70.1) before enrolment in the model. Nineteen (5.2%) PLHIV had dropped out of the model at the time of the data abstraction: one lost from care, two relocated, and 16 returned to facility-based care. The increase in the mean viral load count observed after enrollment was not statistically significant (p = 0.220). Participants on the second-line ART regimen were less likely to be retained compared to those on the first-line regimen (aRR = 0.6, 95% CI: 0.4-1.0, p = 0.028).

CONCLUSION

Under real-world programmatic conditions, at a public peri-urban hospital in Uganda, the CRPDDP model sustained high continued participation and viral load suppression among PLHIV who had spent at least one year in the model, demonstrating its potential as an alternative to facility-based ART distribution. However, the lower continued participation among PLHIV on second-line regimens underscores the need for specialized support strategies. Moreover, the viral load increased slightly, although the change was not statistically significant, this warrants further investigation. Longer follow-up studies that also overcome other limitations of this study could provide more insightful results and long-term sustainability.