Lwevola Paul, Katwesigye Rodgers, Kimuli Derrick, Walusaga Happy Annet, Twinomujuni Ibrahim, Nangendo Joan, Ddumba Immaculate, Ntuuyo Fred, Kyobutungi Sheila, Kawuma Samuel, Arinaitwe Moses, Semitala Fred C
Makerere University Joint AIDS Program, Kampala, Uganda.
United States Agency for International Development Strategic Information Technical Support Activity, Social & Scientific Systems, Inc., DLH Holdings Company, Kampala, Uganda.
BMC Health Serv Res. 2025 Aug 6;25(1):1034. doi: 10.1186/s12913-025-13229-z.
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.
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.
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).
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.
乌干达约有130万艾滋病毒感染者（PLHIV）在医疗机构接受抗逆转录病毒治疗（ART）。乌干达卫生部（MoH）引入了社区零售药店药品分发点（CRPDDP），以减轻医疗机构的负担，提高效率、便利性并提供以患者为中心的护理，同时保持服务质量。本研究调查了在乌干达伊甘加区医院参加CRPDDP至少一年的PLHIV中该模式的持续参与情况和病毒载量抑制情况。
这是一项于2024年1月至3月采用普查方法进行的回顾性队列研究。回顾了2021年10月至2022年12月期间参加CRPPDP模式的360名PLHIV的记录。选择该时间段是为了考虑滚动入组情况。纳入标准要求在研究时自入组起至少有12个月，无论患者是否仍在该模式中。使用具有稳健标准误的对数二项回归分析在5%的显著性水平下评估该模式的持续参与情况、入组时的病毒载量、最新病毒载量（研究时）以及相关因素。
参与者的平均年龄为43.5（±9.8）岁，大多数参与者为女性（占62.2%）且已婚（占53.9%）。该模式的持续参与率为94.7%（95%置信区间：91.9 - 96.8）。在该模式下的平均病毒抑制水平为96.3拷贝/毫升（95%置信区间：43.3 - 149.4），而在入组该模式之前为63.2拷贝/毫升（95%置信区间：56.3 - 70.1）。在数据提取时，有19名（5.2%）PLHIV退出了该模式：1人失访，2人搬迁，16人转回基于医疗机构的护理。入组后观察到的平均病毒载量计数增加无统计学意义（p = 0.220）。与接受一线治疗方案的参与者相比，接受二线抗逆转录病毒治疗方案的参与者被保留的可能性较小（调整风险比 = 0.6，95%置信区间：0.4 - 1.
