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Effect of Active Follow-Up on Viral Load Suppression among People Living with HIV on Intensive Adherence Counseling in Uganda: An Instrumental Variable Analysis
Jonathan Izudi
jonahzd@gmail.com
Jonathan Izudi
Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda;
African Population and Health Research Center, Nairobi, Kenya;
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African Population and Health Research Center, Nairobi, Kenya;
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Solomon Paul Okot
Solomon Paul Okot
Makerere University School of Public Health (MakSPH), Kampala, Uganda;
Baylor College of Medicine Children’s Foundation, Mulago Hospital Complex, Kampala, Uganda;
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Baylor College of Medicine Children’s Foundation, Mulago Hospital Complex, Kampala, Uganda;
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Allan Komakech
Allan Komakech
Africa Centers for Disease Control and Prevention (Africa CDC), Kinshasha, The Democratic Republic of Congo;
Clarke International University, Kampala, Uganda
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Clarke International University, Kampala, Uganda
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Francis Bajunirwe
Francis Bajunirwe
Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda;
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We assessed the effect of active follow-ups on viral load (VL) suppression among people living with HIV (PLWH) who had missed their clinic visit(s) and were receiving intensive adherence counseling (IAC) at a large referral hospital in mid-western Uganda. We designed a quasi-experimental study, using a locator map (a local map showing residence) as an external factor (instrumental variable) that influenced active follow-up. We performed instrumental variable analysis. Of the 165 participants included, 24.8% had a client locator map, and possessing a map was associated with active follow-up (F-statistics 53.1; P <0.0001). Active follow-up did not significantly improve VL suppression at varying cutoffs, namely <1,000 copies/ml (P = 0.607), less than 200 copies/ml (P = 0.684), and less than 50 copies/ml (P = 0.435). Although active follow-up did not significantly improve VL suppression among PLWH on IAC, it showed a modest trend toward improvement. Large, randomized trials are needed.
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Author Notes
Disclosure: The Makerere University School of Public Health Higher Degrees Research and Ethics Committee approved the parent study (reference number: HDREC 2017/HD07/1965U).
Current contact information: Jonathan Izudi, Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda, E-mail: jonahzd@gmail.com. Solomon Paul Okot, Makerere University School of Public Health, Kampala, Uganda, E-mail: paulsolomonokot@gmail.com. Allan Komakech, Africa Centers for Disease Control and Prevention, Kinshasha, The Democratic Republic of Congo, E-mail: komallanokot@gmail.com. Francis Bajunirwe, Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda, E-mail. fbaj@yahoo.com.
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