Linkage to HIV care among adults with positive oral HIV self-test results in Central Uganda : a mixed-methods study

Abstract

Background: Linkage to HIV care after testing positive on oral HIV self-testing is low in Uganda This study aimed at determining the proportion of adults with positive oral HIV self-testing results linked to HIV care and the factors associated with linkage to HIV care. We further explored barriers and facilitators of linkage to HIV care among adults testing positive with oral HIV self-testing in Central Uganda. Methods: This was a mixed-methods study carried out at selected health facilities in Central Uganda between July to August 2020. HIVST medical records of 243 HIV positive participants were reviewed. One hundred forty-four and 9 participants were interviewed with structured questionnaires and an in-depth interview guide respectively. Demographic, socioeconomic factors, health-related factors were compared with and Linkage to HIV care using robust modified poison logistic regression utilising prevalence risk ratio as a measure of association.the Ethical approval was obtained and participants provided written consent. Results: 243 medical records were reviewed, with a proportion of linkage to HIV care as 69.5%(169/243) among individuals who tested positive on oral HIV self-testing. Among the 144 participants invited for interviews, the majority of them were female(104/144) with a mean age (SD) of 29(±8) years. Age(APRR:1.37 95% CI:1.01-1.87), directly assisted HIVST(PRR:1.93, 95% CI: 1.52-2.44), HIV status disclosure(PRR: 1.32, 95% CI: 1.03-1.69), and readiness to start ART(PPR:1.85, 95% CI: 1.25-2.74) were positively associated with linkage to HIV care. consuming alcohol(APRR: 1.25, 95% CI: 1.03-1.51), thoughts of unfair treatment(APRR: 0.67, 95% CI: 0.46-0.95), and getting ART side effects(APRR: 0.43, 95% CI: 0.26-0.69) were negatively associated with linkage to HIV care. Barriers to linkage to HIV care included HIV-associated stigma, the lack of privacy, and perceived good health. The awareness of responsibility and good quality health care were identified as facilitators of linkage to HIV care. Conclusion: Linkage to HIV care among adults with positive HIV oral self-testing results is lower than the Joint United Nations Programme on HIV/AIDS target of 95-95-95 and several factors influence access to HIV care. There is need to design interventions that guide follow up and engagement of individuals who test positive with oral HIV self-testing to encourage prompt linkage to HIV care.