Kuala Lumpur, Malaysia, 30 June - 3 July 2013 Outcomes of newly diagnosed HIV- infected patients referred to care after Provider Initiated HIV Counseling and Testing (PITC) in Uganda July 1 st 2013 Dalsone Kwarisiima MD, MPH F Semitala, J Ngabirwe, N Matsiko, S Muhumuza, J Namusobya, C Nawavvu and M R. Kamya Makerere University Joint AIDS Program

Kuala Lumpur, Malaysia, 30 June - 3 July 2013 Background  Successful HIV care requires; -early identification of HIV infected individuals -immediate linkage to care - long-term retention on potent ART  Less than 60% are assessed for ART eligibility within 3 months following a positive HIV test 1 1 Rosen, 2011

Kuala Lumpur, Malaysia, 30 June - 3 July 2013

Kuala Lumpur, Malaysia, 30 June - 3 July 2013 Background continued  MJAP has provided PITC in large national referral and teaching hospitals since 2004  Identified HIV-infected patients are referred to clinics of their choice  Outcome of referrals of newly diagnosed HIV- infected patients is largely unknown

Kuala Lumpur, Malaysia, 30 June - 3 July 2013 Objectives  Evaluate outcomes of referral of HIV-infected Patients identified through PITC  Evaluate access to CD4 testing and ART among patients linked to care.

Kuala Lumpur, Malaysia, 30 June - 3 July 2013 Methods  We reviewed PITC registers between Nov 2011 and March 2012  A total of 19,794 patients received PITC  2327 were HIV-infected  867 were randomly selected  We interviewed the selected on phone  For unsuccessful initial phone call, two more attempts were made  We collected data on : – Patient’s vital status – Social demographics – Dates of HIV test and enrollment into HIV care – Reasons for non-linkage – Access to baseline CD4 testing – Access to ART  Used logistic regression to analyze for predictors of linkage

Kuala Lumpur, Malaysia, 30 June - 3 July 2013 Results  We ascertained outcomes for 70% (620/867) of interviewed  Successfully completed the calls for 81% (500/620)  Majority were females (55%)  Mean age was 31 years (SD,9.4)

Kuala Lumpur, Malaysia, 30 June - 3 July 2013 Outcomes of phone contacts made n=867

Kuala Lumpur, Malaysia, 30 June - 3 July 2013 Out comes of referrals N= 500  Linked to care 91%, (454/500)  Not linked 9%, (46/500)  Median time from diagnosis to linkage was 3 months, (IQR=2 - 5)

Kuala Lumpur, Malaysia, 30 June - 3 July 2013 Reasons for Non-linkage n=46

Kuala Lumpur, Malaysia, 30 June - 3 July 2013 Factors associated with Linkage to HIV care Predictor/Factor Linked to CareOddsP-valueCI YesNo Sex Male Female Age group< ≥ Education level Primary and below Secondary Tertiary Marital Status Single Windowed Divorced Married

Kuala Lumpur, Malaysia, 30 June - 3 July 2013 Access to CD4 testing and ART CD4 Testing(n=500)  Had a CD4 done = 441(88%)  Had Not yet had CD4 done = 19(4%)  Not sure if CD4 was done = 40(8%) ART(n=500)  On ART = 275(60%)  Not on ART=181(39%)  Unknown=5(1%)

Kuala Lumpur, Malaysia, 30 June - 3 July 2013 Limitations  Recall bias  A third of patients could not be reached, so their outcomes could not be ascertained  Our findings on linkage at a large national referral hospital may have limited generalizability.

Kuala Lumpur, Malaysia, 30 June - 3 July 2013 Conclusion  Majority of the patients successfully tracked were in care  Outcomes a third of newly diagnosed HIV patients was not ascertained  Being single and younger age were predictors of not being in care  Need to design Strategies for active linkage and follow up of identified HIV positive

Kuala Lumpur, Malaysia, 30 June - 3 July 2013 Acknowledgement  HIV patients who participated  MJAP PITC team  Mulago Hospital Staff  PEPFAR and CDC