JMIR Publications

ABSTRACT

Background:

The iDARE methodology is implemented at the community-level to address root causes of low HIV antiretroviral therapy adherence among men and children actively enrolled in care resulting in low viral load suppression (VLS) in Tororo and Kapachorwa districts in Uganda. The methodology supports locally led sustainable solutions to address gender, youth, and social inclusion (GYSI) issues to reduce barriers to care and reach the 95-95-95 UNAIDS target for HIV epidemic control.

Objective:

The primary objective of this study will be to measure the impact of the implementation of iDARE on VLS for men and children living with HIV who are active in care. The secondary objective is to investigate the scale up of iDARE using evidence-based GYSI Social Behavior Change Packages to rapidly meet MOH targets of VLS for men and children.

Methods:

A retrospective cohort study design will be used to analyze ongoing program data that aims to increase the rates of VLS in men and children who are classified as active in care using community engagement and quality improvement techniques. Cohorts are defined as actively enrolled men and children in care at the time of baseline data collection for three facilities in two districts in Uganda. We will analyze data on the proportion of men and children with suppressed VLS from three health centers at up to 12 months of implementation. VLS data is routinely collected from these health facilities through a USAID funded program aimed at social behavior change to increase health-seeking behavior in Uganda. The expected outcomes will be two-fold. First, the proportion of men who are alive, in care, and achieve VLS at the 3 sites by the end of September 2021 and the second, the proportion of children who are alive, in care, and achieve VLS at the three sites by the end of September 2021.

Results:

Implementation began in September 2020 in Tororo District at Nagongera Health Center IV, followed by Mulanda Health Center IV in October 2020, then in Kapachorwa District at Kabeywa Health Center III in February 2021. Baseline was assessed the preceding month before implementation at each of the sites to assess for the total number of men and children classified as active in care and the total number of those that were active in care that had achieved viral load suppression. Across all sites, on average at baseline 72% of males and 63% of children had achieved viral load suppression.

Conclusions:

This study can contribute to the global evidence base in understanding GYSI issues impacting VLS, specifically among men and children, and introducing a methodology that supports community developed and led solutions to overcoming these issues and improving VLS that may be scaled to the national level.