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Assessment of the effect of Community Differentiated Service Delivery models on Viral load suppression among children and adolescents living with HIV in Uganda
Published onJun 15, 2023
Assessment of the effect of Community Differentiated Service Delivery models on Viral load suppression among children and adolescents living with HIV in Uganda
Background
Viral load suppression (VLS) for Children and Adolescents Living with HIV (CALHIV) in Uganda has improved but remains low at 74% compared to that of adults (91%), DHIS2 2021. This has been due to sub-optimal ARV regimens, non-adherence to treatment due to psycho-social and drug administration challenges. With support from PEPFAR, Uganda started implementing community Differentiated Services Delivery (DSD) models for children (>2 years) and adolescents (10-19 years) living with HIV in 2020. Facility models include; |Facility-based individual management model (FBIM), Facility-based groups (FBGs), Fast track drug refill (FTDR) while community models include; Community Drug Distribution Point (CDDP) and Community Client Led ART Distribution (CCLAD). A national DSD dashboard was developed to monitor VLS among clients on DSD models, by DSD type. We set to assess the effect of community DSD models on VLS among CALHIV across the country.
Methods
We retrospectively analyzed data for CALHIV from the DSD dashboard for all HIV anti retro viral (ART) clinics in Uganda from July 2021–September 2021. This dashboard pulls data from DHIS2 the national reporting system on a quarterly basis. Descriptive analysis included data on demographics and VLS for community DSD models.
Results
Among 92,562 CALHIV active on ART during July–September 2021, 56.2% were females and 43.8% were males. Of these, 74.4% were in Facility-based models, 21.0% were in community models, 4.6% un categorized; 28.9% were in FBIM, 45.5% in FBGs, 17.9% in FTDR, 1.6% in CDDP, 1.5% in CCLAD. VLS among community DSD models did not differ by sex (Males = 67.0% vs Females = 66.0%, p-value >0.05) and by community DSD type CCLAD (62.0%) vs CDDP (61.0%), p-value>0.05). Among children, VLS (<1000 copies) was 62.0% and 75.0% among adolescents living with HIV receiving ART under a community DSD model.
Conclusion
We observed lower viral load suppression for children and a comparable VLS for adolescents in community DSD models, compared to the national VLS. However, there was no significant difference in VLS among the two community DSD models. Children and adolescents living with HIV can still benefit from community DSD models, however, psychosocial support should be strengthened, especially for children.
