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Volume 10 Supplement 1

7th Annual Conference on the Science of Dissemination and Implementation in Health

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Nurse-targeted care for HIV positive persons with CD4<100 improved time to ART initiation and retention in Uganda

Implementation Science volume 10, Article number: A81 (2015) Cite this article

Background

HIV testing and retention in care treatment are key strategies towards an AIDS free generation. Immediate treament of HIV patients with the lowest CD4 T cell counts is critical given their high rates of pre-antiretroviral therapy mortality. We evaluated the impact of adding an additional nurse-counsellor on HIV outcomes among patients enrolled in care in 7 urban public clinics in Kampala, Uganda.

Methods

One additional research nurse per clinic was specifically tasked with identifying and tracking HIV-infected persons with CD4<100 cells/μL who were lost, and expediting ART initiation among patients enrolled after July 2012. Data were also retrospectively collected on all patients with CD4<100 cells/μL that registered at these clinics in the latter six months of 2011. We compared time from CD4 blood draw to ART initiation, frequency of CD4 testing and 6 month retention-in-care by time period. Analyses of categorical and continuous variables were conducted using Χ2 and Mann-Whitney tests.

Results

A total of 258 patients in the 2011 cohort and 593 in the 2012 cohort completed 6 months from clinic registration. Median age of patients in both cohorts was 32 years and 55% were female. Median CD4 cells/μL [Interquartile, IQR] count in the 2011 cohort was 34 [13, 61] and 43 [19, 71] in 2012 (p < 0.002). Median days from CD4 blood draw to ART initiation reduced from 42 [IQR: 28, 56] in the 2011 to 33 [IQR: 21, 47] in 2012, p < 0.001. Six-month retention in care was 62.0% (160/258) in 2011 cohort compared to 75.9% (450/593) in 2012 (p < 0.001). Among the patients retained in care, 24.4% (39/160) received a CD4 count test at 6 months versus 53.3% (240/450) in the 2012 cohort.

Conclusion

The addition of one nurse per clinic to identify and follow severely immune-compromised new clinic patients with CD4<100 led to improved patient care and better outcomes. Funder: The study is an Implementation Science project funded by CDC.

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Authors and Affiliations

  1. Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, 256, Uganda

    Agnes N Kiragga, Elizabeth Nalintya, Joanita Kigozi & David B Meya

  2. Division of Infectious Disease and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN, 55455, USA

    Bozena Morawski, David R Boulware & David B Meya

  3. Division of Global HIV/AIDS (DGHA), Center for Global Health (CGH), Centers for Disease Control and Prevention, Atlanta, GA, 30333, USA

    Benjamin J Park & Jonathan E Kaplan

  4. School of Medicine, College of Health Sciences, Makerere University, Kampala, 256, Uganda

    David B Meya

  5. Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA

    Yukari C Manabe

Authors
  1. Agnes N Kiragga
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  2. Elizabeth Nalintya
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  3. Bozena Morawski
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  4. Joanita Kigozi
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  5. Benjamin J Park
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  6. Jonathan E Kaplan
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  7. David R Boulware
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  8. David B Meya
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  9. Yukari C Manabe
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Corresponding author

Correspondence to Agnes N Kiragga.

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This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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Cite this article

Kiragga, A.N., Nalintya, E., Morawski, B. et al. Nurse-targeted care for HIV positive persons with CD4<100 improved time to ART initiation and retention in Uganda. Implementation Sci 10 (Suppl 1), A81 (2015). https://doi.org/10.1186/1748-5908-10-S1-A81

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  • DOI: https://doi.org/10.1186/1748-5908-10-S1-A81

Keywords

Implementation Science

ISSN: 1748-5908