Factors associated with completion of intensive adherence counselling sessions among virologically non-suppressed HIV positive patients on ART at Fort Portal regional hospital, Uganda.

Abstract

Background: In HIV positive patients on anti-retroviral therapy (ART) with Non-suppressed viral load, intensive adherence counselling sessions (IAC) and assessment for viral re-suppression is vital for timely clinical decisions, reduction of mortality, morbidity and cost of ART. In Fort Portal regional referral hospital, annual report of 2018 indicated that only 67% of the patients completed IAC. Despite trainings and mentorships, motivational counselling to resolve this problem has not been effective as data on specific factors to address during IAC sessions was limited. Equally, several studies in Uganda have documented varying IAC completion rates with limited correlates of IAC sessions completion to a wider HIV population. Since the associated factors that could guide design of specific interventions were limited, an inquiry was required. The objective of this study was to examine the factors associated with completion of IAC sessions among virologically non-suppressed HIV positive patients on ART at Fort Portal regional hospital.

Methods: This was a Cross-sectional study design. 420 non-suppressed HIV positive patients on ART at Fort Portal referral hospital from January 2018 to September 2019 were randomly selected for the study. 15 key informants were purposively interviewed till saturation, interviews were audio recorded and transcribed verbatim. A pre-tested semi-structured questionnaire and data abstraction tool were then input into the Open Data Kit (ODK) and data were collected using android mobile phones and submitted to an online server at Baylor Uganda by trained research assistants. A key informant guide and audio recorder were used to collect qualitative data by principal investigator. Quantitative data was then downloaded and transferred into STATA software version 14.0 and merged for analysis. Modified Poisson regression analysis, with robust standard errors was used to determine association between IAC sessions completion and independent variables at 95% CI. Qualitative data were analyzed using the content analysis and summarized into themes. Results: Out of 420 participants enrolled in the study, 282 (67.1%) completed IAC sessions. At multivariable analysis, IAC sessions completion was less likely among participants with secondary/beyond education level compared to those without (Adjusted prevalence ratio (aPR), 0.79; 95% CI, 0.64-0.98; p = 0.031), among those not followed up for IAC compared to those followed up (aPR, 0.76; 95% CI, 0.67-0.87; p<0.001), and among malnourished compared to well-nourished (aPR, 0.65; 95% CI, 0.43-0.99; p = 0.046). However, it was more likely among the separated/widowed or divorced than the single or never married (aPR 1.23; 95%CI, 1.01-1.49; p = 0.042). Qualitatively, patient tracking, pre-appointment reminders, motivational health education, home based IAC were health system facilitators; whereas unfavorable health facility setting, poorly filled IAC tools, flexibility absence, group IAC, integration, task shifting, transport, multiple care takers, child headed homes, schooling and mobile adolescents were barriers. Conclusions: IAC completion of 67.1% was low compared to 100% Uganda MOH standard and associated with education level, malnutrition, marital status, peer led follow up, and home-based IAC, appointment tracking, health system related and patient socio-economic hindrances. We recommend nutritional assessment/counseling, differentiated IAC, documentation and further research.