Predictors of delayed Anti-Retroviral Therapy initiation among adults referred for HIV treatment in Uganda: A cross-sectional study

Abstract

Background Uganda’s current guidelines recommend immediate initiation of Anti-Retroviral Therapy (ART) for persons living with HIV (PLHIV) in order to reduce HIV/AIDS related morbidity and mortality. However, not all eligible PLHIV initiate ART within the recommended time following HIV diagnosis. We assessed the prevalence and factors associated with delayed ART initiation among PLHIV referred for ART initiation, five years after rolling out the test and treat guidelines. Methods In this cross-sectional study, data on socio-demographic characteristics, HIV diagnosis and referral circumstances, and time to ART initiation, was collected from adult PLHIV referred to Mulago Immune Suppressive syndrome (Mulago ISS) clinic for ART initiation from January 2017 to May 2021. Multivariable logistic regression was performed and significant factors identified. A p-value of ≤ 0.05 was considered significant. Results A total of 312 participants were enrolled in the study with 62.2% female. The median (IQR) age of the participants was 35 (28–42) years and baseline CD4 count was 315 (118.8-580.5) cells/µL. Forty-eight, 48 (15.4%) of the participants delayed ART initiation and had a median (IQR) time to ART of 92 (49–273.5) days. The odds of delayed ART initiation were higher among: 1) patients who had their HIV diagnosis made from a private health facility versus public health facility (adjusted odds ration [aOR] = 2.5 (95% confidence interval [CI] 1.1–5.7); 2) patients who initially denied their positive HIV test results versus those who accepted aOR = 5 (95% CI: 1.7–14.9); and 3) not receiving a follow up phone call from the place of HIV diagnosis compared to PLHIV who received aOR = 2.8 (95% CI: 1.2–6.8). Conclusion There was significant delay of ART initiation among referred PLHIV five years after the rollout the test and treat guidelines in Uganda. Standardized post HIV diagnosis patient follow up at private health facilities including use of telephone calls would facilitate improved timely linkage to ART among newly diagnosed PLHIV in Uganda and similar settings.