How does HIV testing modality impact the cascade of care among persons diagnosed with HIV in Ethiopia?
Johansson, Malin LU ; Penno, Clara ; Winqvist, Niclas LU ; Tesfaye, Fregenet LU and Björkman, Per LU
(2021)
In Global Health Action
14(1).
- Abstract
Background: Despite scaling up of HIV programmes in sub-Saharan Africa, many people living with HIV (PLHIV) are unaware of their HIV status. New testing modalities, such as community-based testing, can improve test uptake, but it is uncertain whether type of testing modality affects the subsequent cascade of HIV care. Objective: To compare linkage to care and antiretroviral treatment (ART) outcomes with regard to type of HIV testing modality. Methods: A retrospective registry-based study was conducted at public ART clinics in an urban uptake area in Central Ethiopia. Persons aged ≥15 years newly diagnosed with HIV in 2015–2018 were eligible for inclusion. Data on patient characteristics and testing modality were analysed for... (More)
Background: Despite scaling up of HIV programmes in sub-Saharan Africa, many people living with HIV (PLHIV) are unaware of their HIV status. New testing modalities, such as community-based testing, can improve test uptake, but it is uncertain whether type of testing modality affects the subsequent cascade of HIV care. Objective: To compare linkage to care and antiretroviral treatment (ART) outcomes with regard to type of HIV testing modality. Methods: A retrospective registry-based study was conducted at public ART clinics in an urban uptake area in Central Ethiopia. Persons aged ≥15 years newly diagnosed with HIV in 2015–2018 were eligible for inclusion. Data on patient characteristics and testing modality were analysed for associations with the following outcomes: ART initiation, retention in care at 12 months after starting ART, and viral suppression (<1000 copies/ml, recorded during the first 12 months after ART initiation), using uni- and multivariable analysis. Separate analyses disaggregated by sex were performed. Results: Among 2885 included PLHIV (median age 32 years, 59% female), 2476 (86%) started ART, 1422/2043 (70%) were retained in care, and 953/1046 (92%) achieved viral suppression. Rates of ART initiation were lower among persons diagnosed through community-based testing (adjusted odds ratio [AOR] 0.44, 95% confidence interval [CI] 0.29–0.66) and among persons diagnosed through provider-initiated testing (AOR 0.65, 95% CI 0.44–0.97) compared with facility-based voluntary counselling and testing. In sex-disaggregated analyses, community-based testing was associated with lower rates of ART initiation among both women and men (AOR 0.47, 95% CI 0.27–0.82; AOR 0.39, 95% CI 0.19–0.78, respectively). No differences were found for retention in care or viral suppression with regard to test modality. Conclusion: Type of HIV testing modality was associated with likelihood of ART initiation, but not with subsequent treatment outcomes among persons starting ART.
(Less)
- author
- Johansson, Malin
LU
; Penno, Clara
; Winqvist, Niclas
LU
; Tesfaye, Fregenet
LU
and Björkman, Per
LU
- organization
- publishing date
- 2021
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- cascade of care, community-based testing, Ethiopia, HIV, test modality
- in
- Global Health Action
- volume
- 14
- issue
- 1
- article number
- 1933788
- publisher
- Co-Action Publishing
- external identifiers
-
- scopus:85113168394
- pmid:34402766
- ISSN
- 1654-9716
- DOI
- 10.1080/16549716.2021.1933788
- language
- English
- LU publication?
- yes
- id
- 058e8351-3aeb-42cd-8946-4bc016cb71ec
- date added to LUP
- 2021-09-06 11:02:00
- date last changed
- 2024-06-15 15:48:49
@article{058e8351-3aeb-42cd-8946-4bc016cb71ec,
abstract = {{<p>Background: Despite scaling up of HIV programmes in sub-Saharan Africa, many people living with HIV (PLHIV) are unaware of their HIV status. New testing modalities, such as community-based testing, can improve test uptake, but it is uncertain whether type of testing modality affects the subsequent cascade of HIV care. Objective: To compare linkage to care and antiretroviral treatment (ART) outcomes with regard to type of HIV testing modality. Methods: A retrospective registry-based study was conducted at public ART clinics in an urban uptake area in Central Ethiopia. Persons aged ≥15 years newly diagnosed with HIV in 2015–2018 were eligible for inclusion. Data on patient characteristics and testing modality were analysed for associations with the following outcomes: ART initiation, retention in care at 12 months after starting ART, and viral suppression (<1000 copies/ml, recorded during the first 12 months after ART initiation), using uni- and multivariable analysis. Separate analyses disaggregated by sex were performed. Results: Among 2885 included PLHIV (median age 32 years, 59% female), 2476 (86%) started ART, 1422/2043 (70%) were retained in care, and 953/1046 (92%) achieved viral suppression. Rates of ART initiation were lower among persons diagnosed through community-based testing (adjusted odds ratio [AOR] 0.44, 95% confidence interval [CI] 0.29–0.66) and among persons diagnosed through provider-initiated testing (AOR 0.65, 95% CI 0.44–0.97) compared with facility-based voluntary counselling and testing. In sex-disaggregated analyses, community-based testing was associated with lower rates of ART initiation among both women and men (AOR 0.47, 95% CI 0.27–0.82; AOR 0.39, 95% CI 0.19–0.78, respectively). No differences were found for retention in care or viral suppression with regard to test modality. Conclusion: Type of HIV testing modality was associated with likelihood of ART initiation, but not with subsequent treatment outcomes among persons starting ART.</p>}},
author = {{Johansson, Malin and Penno, Clara and Winqvist, Niclas and Tesfaye, Fregenet and Björkman, Per}},
issn = {{1654-9716}},
keywords = {{cascade of care; community-based testing; Ethiopia; HIV; test modality}},
language = {{eng}},
number = {{1}},
publisher = {{Co-Action Publishing}},
series = {{Global Health Action}},
title = {{How does HIV testing modality impact the cascade of care among persons diagnosed with HIV in Ethiopia?}},
url = {{http://dx.doi.org/10.1080/16549716.2021.1933788}},
doi = {{10.1080/16549716.2021.1933788}},
volume = {{14}},
year = {{2021}},
}