JMIR Publications

ABSTRACT

Background In collaboration with facilities, communities, district local government, and USAID implementing partners, the iDARE methodology is being 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 in Tororo and Kapachorwa districts, Uganda. The methodology develops capacity in co-creating locally led sustainable solutions to address gender, youth, and social inclusion issues to reduce barriers to care and reach the 95-95-95 UNAIDS target for HIV epidemic control. For men, gender, youth, and inclusion issues found to contribute to HIV outcomes were extramarital affairs, excessive alcohol and smoking, gender-based violence, and sending wives (and or partners) to the facility on their behalf for appointments and collecting mediation. For children, the most common issues found were lack of support from parents/ caretakers, staying with elderly grandparents or others, lack of food, and labor and poverty induced stress. We aim to measure the impact of iDARE on viral load suppression for men and children active in care. Methods A retrospective cohort study design will be used to analyze ongoing program data that aims to increase the rates of viral load suppression 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 actively enrolled children in care at the time of baseline data collection for three facilities in two districts in Uganda. We will use the paired t test to analyze before and after data on proportion of men and children with suppressed VL from three health centers 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. Based on the iDARE process and results, change packages are developed to highlight lessons learned and share best practices in order to share with subsequent sites. The expected primary outcomes will be two-fold. First, the proportion of men who are alive, in care, and achieve viral suppression at the 3 sites by the end of September 2021 and the second, the proportion of children who are alive, in care, and achieve viral suppression at the 3 sites by the end of September 2021.