| dc.description.abstract | Introduction; In 2020, there were about 1.75 million adolescents living with HIV (ALWHIV) around the world. Approximately 1.5 million HIV-infected adolescents were from Sub-Saharan Africa, and by the end of 2019, about 7% of the people living with HIV (PLHIV) in Uganda were adolescents. Remaining in HIV health care services is necessary for adhering to antiretroviral therapy, viral suppression, assessing drug adverse effects, and diagnosing treatment failure. However, retention in HIV care among ALWHIV has for long been a major challenge yet the implementation of the COVID-19 restriction measures might have worsened it.
Aim; We aimed at assessing the effect of COVID-19 restrictive measures on the retention of ALWHIV at Naguru Hospital between April 2019 and March 2022.
Methods; A mixed-methods sequential exploratory design was conducted among 120 adolescents who received care at the HIV clinic of Naguru Hospital between April 2019 to March 2022. The quantitative study was a retrospective chart review and the qualitative study was an exploratory study design. An abstraction tool and interview guides were used to collect all the necessary information needed to achieve the objectives. Interrupted Time Series Analysis (ITSA) and Generalized Estimating Equations (GEE) were used to assess the change in the retention pattern before and after the implementation of COVID-19 restrictive measures and determine the factors associated with retention in HIV care respectively at a <0.05 level of significance. Retention in HIV care was, defined as having had at least one visit per quarter of the study.
Results: The majority of the participants were aged 15-19 years (65.0%) and were female (69.2%). According to adjusted analyses, the number of ALWHIV retained in HIV care immediately decreased on arrival of the COVID-19 restrictive measures (p=0.006) and gradually increased there after (p=0.002). Age (p<0.001), type of home-based caregiver (p=0.,008) and time (p<0.001) were independently associated with retention in care. However, factors like Viral load, sex, ART regimen, and location were not related to retention in care. Transportation difficulties and peer support groups were among the barriers and facilities of retention in HIV care respectively among ALWHIV after the COVID-19 restrictive measures were implemented.
Conclusion: COVID-19 restrictive measures negatively impacted the retention of ALWHIV in HIV care. Being a younger adolescent, having a parent as the caregiver at home and an increase in time were associated with retention in HIV care. There is need to develop new retention strategies that integrate support from both family members, peers and healthcare workers in addition to strengthening those in existence for such a critical group if the UNAIDS 95-95-95 strategy is to be achieved. | en_US |
