Nurse-targeted care for HIV positive persons with CD4<100 improved time to ART initiation and retention in Uganda
© Kiragga et al. 2015
Published: 14 August 2015
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.
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.
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.
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.
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.