Determinants of acceptance of same-day Antiretroviral therapy initiation among clients attending public health facilities in Nakawa Division,Kampala District

Abstract

Introduction Uganda has adopted the HIV test and treat policy which requires same day ART initiation after HIV diagnosis in order to meet the 90-90-90 HIV global targets and end the AIDS epidemic by 2030. However despite increase in proportion of HIV positive clients on ART since adoption of the policy, no literature exist on acceptance of same day ART initiation in the general HIV population. The aim of this study was to assess the determinants of acceptance of same-day ART initiation among clients attending public health facilities in Nakawa division, Kampala district. Methods This was a cross sectional descriptive study conducted in two public health facilities in Nakawa division, Kampala district. One regional referral hospital and one health centre IV were purposively selected from which 402 newly diagnosed HIV positive clients were consecutively selected. Information on antiretroviral therapy acceptance and associated factors was obtained using interviewer administered questionnaires. Data management and analysis was done using STATA 13.0. Numerical variables were summarized using mean and standard deviation of the mean (SD) and bivariate analysis was done to compare antiretroviral therapy acceptance among the different socio-demographic categories, health facility factors, other individual factors and treatment factors using cross-tabulation with a Chi-square test. Modified Poisson regression was used to determine factors associated with acceptance same-day ART initiation. Results Out of the 400 participants, 226 (56.5%) were female; the mean age was 30 years. The overall acceptance of same day ART initiation was 93.7%. HIV positive clients were more likely to accept same day ART initiation when drugs were present at time of diagnosis (P<0.01), perceived their health providers to strongly recommend ART initiation (P=0.046) and perceived HIV counselling services to be adequate (P=0.01). Conclusion Same-day ART initiation acceptance rates were high. However, it can be improved even further when HIV care providers strongly recommend same day ART initiation , provision of adequate pre and post HIV counselling and ensuring sufficient ART drug supplies at the facilities.