Incidence of Health Facility Switching and Associations With HIV Viral Rebound Among Persons on Antiretroviral Therapy in Uganda: A Population-based Study.

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  • Additional Information
    • Source:
      Publisher: Oxford University Press Country of Publication: United States NLM ID: 9203213 Publication Model: Print Cited Medium: Internet ISSN: 1537-6591 (Electronic) Linking ISSN: 10584838 NLM ISO Abbreviation: Clin Infect Dis Subsets: MEDLINE
    • Publication Information:
      Publication: Jan. 2011- : Oxford : Oxford University Press
      Original Publication: Chicago, IL : The University of Chicago Press, c1992-
    • Subject Terms:
    • Abstract:
      Background: A substantial proportion of persons on antiretroviral therapy (ART) considered lost to follow-up have actually transferred their human immunodeficiency virus (HIV) care to other facilities. However, the relationship between facility switching and virologic outcomes, including viral rebound, is poorly understood.
      Methods: We used data from 40 communities (2015-2020) in the Rakai Community Cohort Study to estimate incidence of facility switching and viral rebound. Persons aged 15-49 years with serologically confirmed HIV who self-reported ART use and contributed ≥1 follow-up visit were included. Facility switching and virologic outcomes were assessed between 2 consecutive study visits (ie, index and follow-up visits, interval of approximately 18 months). Those who reported different HIV treatment facilities between index and follow-up study visits were classified as having switched facilities. Virologic outcomes included viral rebound among individuals initially suppressed (<200 copies/mL). Multivariable Poisson regression was used to estimate associations between facility switching and viral rebound.
      Results: Overall, 2257 persons who self-reported ART use (median age, 35 years; 65% female, 92% initially suppressed) contributed 3335 visit-pairs and 5959 person-years to the analysis. Facility switching was common (4.8 per 100 person-years; 95% confidence interval [CI], 4.2-5.5) and most pronounced in persons aged <30 years and fishing community residents. Among persons suppressed at their index visit (n = 2076), incidence of viral rebound was more than twice as high in persons who switched facilities (adjusted incidence rate ratio = 2.27; 95% CI, 1.16-4.45).
      Conclusions: Facility switching was common and associated with viral rebound among persons initially suppressed. Investments in more agile, person-centered models for mobile clients are needed to address system inefficiencies and bottlenecks that can disrupt HIV care continuity.
      Competing Interests: Potential conflicts of interest. The authors: No reported conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest.
      (© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For permissions, please e-mail: [email protected].)
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    • Grant Information:
      R01MH105313 United States MH NIMH NIH HHS; R01 MH107275 United States MH NIMH NIH HHS; 75N91019D00024 United States CA NCI NIH HHS; P30 AI094189 United States AI NIAID NIH HHS; K01 AI125086 United States AI NIAID NIH HHS; R01 AI143333 United States AI NIAID NIH HHS; US President's Emergency Plan for AIDS Relief; K01 MH129226 United States MH NIMH NIH HHS; U01AI100031 National Institute of Allergy and Infectious Diseases; NU2GGH00081 United States CC CDC HHS; T32 AI102623 United States AI NIAID NIH HHS; R01 MH105313 United States MH NIMH NIH HHS; F31 MH126796 United States MH NIMH NIH HHS; D43 TW010557 United States TW FIC NIH HHS
    • Contributed Indexing:
      Keywords: HIV treatment; HIV viremia; clinic transfers; sub-Saharan Africa; viral load suppression
    • Accession Number:
      0 (Anti-HIV Agents)
    • Publication Date:
      Date Created: 20231219 Date Completed: 20240613 Latest Revision: 20240615
    • Publication Date:
      20240615
    • Accession Number:
      PMC11175689
    • Accession Number:
      10.1093/cid/ciad773
    • Accession Number:
      38114162