Revista de SIDA e investigación clínica

Antiretroviral Therapy Programme Retention and Outcomes after 12 Months in a Retrospective Patient Cohort in Fort Portal, Uganda: The Ongoing Challenge of Male ART Performance

Abstract

Stefanie Theuring, Kizito Mugenyi, John Rubaihayo, Priscilla Busingye and Gundel Harms

Background: Antiretroviral therapy (ART) programmes have been extensively scaled-up in countries like Uganda. While success of these programmes largely depends on lasting patient retention, attrition rates are often especially high in the first year after treatment initiation. Our study aimed at analysing recent data of a Ugandan ART patient cohort regarding 12 months ART outcomes and programme retention.

Methods: Virika Hospital in Fort Portal, Western Uganda, is offering ART services according to national treatment standards. A routinely collected patient monitoring database was used for retrospective analysis, following-up 369 patients for 12 months after enrolment. Primary outcome indicator was 12 months retention (being alive and active in programme). We assessed clinical ART progress, attrition, mortality and influencing factors, particularly gender differences.

Results: From 369 ART patients, two-thirds were female. Overall ART outcomes and adherence in this cohort were satisfying, but in men, improvement of CD4-cell counts and weight gain after 12 months were significantly lower than in female patients. In total, one in eight patients (12.2%) was subject to all-cause attrition after 12 months. We identified low CD4-cell count at ART enrolment as the only independent risk factor for attrition after 12 months (p=0.037), while male patients were at highest risk for this, showing significantly lower CD4-cell counts at ART initiation (p=0.008).

Conclusion: We found overall outcomes of this ART programme encouraging, however, attention must be paid particularly to male ART patients. Men were underepresented in our cohort, enrolled in the ART programme at later disease stage, and showed worse ART outcomes after 12 months. Our data suggests that the known challenge of male ART performance is persisting, and that it has not sufficiently been addressed in the past years. Especially the problem of male late-presenters in ART programmes should lead to action in health services planning and implementation, for example by offering more HIV testing opportunities to men.