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Dalsone Kwarisiima MD, MPH

Outcomes of newly diagnosed HIV-infected patients referred to care after Provider Initiated HIV Counseling and Testing (PITC) in Uganda July 1 st 2013. Dalsone Kwarisiima MD, MPH F Semitala, J Ngabirwe, N Matsiko, S Muhumuza, J Namusobya, C Nawavvu and M R. Kamya

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Dalsone Kwarisiima MD, MPH

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  1. Outcomes of newly diagnosed HIV-infected patients referred to care after Provider Initiated HIV Counseling and Testing (PITC) in UgandaJuly 1st 2013 Dalsone Kwarisiima MD, MPH F Semitala, J Ngabirwe, N Matsiko, S Muhumuza, J Namusobya, C Nawavvu and M R. Kamya Makerere University Joint AIDS Program

  2. Background • Successful HIV care requires; -early identification of HIV infected individuals -immediate linkage to care - long-term retention on potent ART • Less than 60% are assessed for ART eligibility within 3 months following a positive HIV test1 1Rosen , 2011

  3. Background continued • MJAP has provided PITC in large national referral and teaching hospitals since 2004 • Identified HIV-infected patients are referred to clinics of their choice • Outcome of referrals of newly diagnosed HIV-infected patients is largely unknown

  4. Objectives • Evaluate outcomes of referral of HIV-infected Patients identified through PITC • Evaluate access to CD4 testing and ART among patients linked to care.

  5. Methods • We reviewed PITC registers between Nov 2011 and March 2012 • A total of 19,794 patients received PITC • 2327 were HIV-infected • 867 were randomly selected • We interviewed the selected on phone • For unsuccessful initial phone call, two more attempts were made • We collected data on : • Patient’s vital status • Social demographics • Dates of HIV test and enrollment into HIV care • Reasons for non-linkage • Access to baseline CD4 testing • Access to ART • Used logistic regression to analyze for predictors of linkage

  6. Results • We ascertained outcomes for 70% (620/867) of interviewed • Successfully completed the calls for 81% (500/620) • Majority were females (55%) • Mean age was 31 years (SD,9.4)

  7. Outcomes of phone contacts made n=867

  8. Out comes of referralsN= 500 Linked to care 91%, (454/500) Not linked 9%, (46/500) Median time from diagnosis to linkage was 3 months, (IQR=2 - 5)

  9. Reasons for Non-linkage n=46

  10. Factors associated with Linkage to HIV care

  11. Access to CD4 testing and ART CD4 Testing(n=500) • Had a CD4 done = 441(88%) • Had Not yet had CD4 done = 19(4%) • Not sure if CD4 was done = 40(8%) ART(n=500) • On ART = 275(60%) • Not on ART=181(39%) • Unknown=5(1%)

  12. Limitations • Recall bias • A third of patients could not be reached, so their outcomes could not be ascertained • Our findings on linkage at a large national referral hospital may have limited generalizability.

  13. Conclusion • Majority of the patients successfully tracked were in care • Outcomes a third of newly diagnosed HIV patients was not ascertained • Being single and younger age were predictors of not being in care • Need to design Strategies for active linkage and follow up of identified HIV positive

  14. Acknowledgement • HIV patients who participated • MJAP PITC team • Mulago Hospital Staff • PEPFAR and CDC

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