Test and treat policy: Effect on ART initiation and retention and health system barriers and facilitators to implementation in AHF Uganda Cares Clinics in Central Uganda

Abstract

Background: The ‘Test and Treat’ policy was introduced by the WHO in 2015 as a measure to extend the benefits of ART to all HIV positive patients and, in a bid to enable the achievement of the UNAIDS 95-95-95 2030 targets. Study Objective: The main objective of this study was to assess the effect of the test and treat policy on the 30-day initiation rate of ART and the one, three and six month retention in care in AHF Uganda cares supported ART clinics in central region, Uganda. The study also sought to explore the health system facilitators and barriers to implementation of test and treat policy. Methods: This was before and after study that utilized secondary data. A total of 5,846 records were examined from 7 sites in central Uganda, 3,191records from 2014 before and 2,655records from 2017, the period after roll out of the T&T policy. The dependent variables were initiation on ART within 30 days and retention in care at 1, 3 and 6 months. The independent variables were sex, age, baseline CD4, baseline WHO clinical stage and the facilities themselves which were chosen purposively. The data was extracted from the Open-MRS and analysed using STATA v14.Frequencies, proportions, median and interquartile range were used to summarize the data. The Chi-square test for independence was used to test for the difference in proportions. A Poisson regression analysis was used to determine adjusted relative rate ratios among those started on ART. Finally, 7Health workers underwent key informant interviews to explore their perceived facilitators and barriers to the implementation of T&T. Manual thematic content analysis was used to analyse this data. Results: The 30-days initiation rate was 62.7% before and 90.8% after the T&T policy rollout. Significant differences observed in the two periods were among patients with advanced disease; 1. Initiated within 30days,73.4% before vs95.2% after (p value: <0.001); 2. Retained in the 1st month of care, 77.8% before vs 91% after(p-value=0.022). There was also an adjusted reduction in retention on ART from before T&T to after of 3% at 1 month, 5% at 3 months and 5% at 6 months. Barriers to implementation were Health worker attitude and increased workload. Conclusion and Recommendations: Test and treat policy improved the 30-day initiation rates and one month retention among patients with advanced disease and should therefore be optimized. MOH should address barriers to implementation of Test and treat Policy.