Access to, and uptake of, antiretroviral therapy in a developing country with high HIV prevalence: A population-based cohort study in rural Uganda, 2004-2008

Abstract

Objectives To investigate antiretroviral therapy (ART) uptake after its introduction in 2004 in a longitudinal population-based cohort and its nested clinical cohort in rural Uganda. Methods A HIV serosurvey of all adults aged ≥15years is conducted annually. Two intervals were selected for analysis. Interval 1 (November 2004-October 2006) provided 2years of follow-up to prospectively evaluate access to HIV services. Interval 2 (November 2007-October 2008) was used to evaluate current coverage of services. Logistic regression was used to identify sociodemographic factors associated with ART screening within 2years of diagnosis. ART coverage was assessed using Weibull survival models to estimate the numbers needing ART. Results In Interval 1, 636 HIV-positive adults were resident and 295 (46.4%) knew their status. Of those, 248 (84.1%) were screened for ART within 2years of diagnosis. After adjusting for age, those who were widowed, separated or never married were more likely to be screened than those who were married. In Interval 2, 575 HIV-positive adults were residents, 322 (56.0%) knew their status, 255 (44.3%) had been screened for ART and 189 (32.9%) had started ART. Estimated ART coverage was 66%. Conclusions In this cohort, ART access and uptake is very high once people are diagnosed. Owing to intensive screening in the study clinic, nearly all participants who were eligible initiated ART. However, this is unlikely to reflect coverage in the general population, intensified efforts are needed to promote HIV testing, and ART screening and uptake are needed among those found to be HIV-positive. © 2012 Blackwell Publishing Ltd.