Browsing by Author "Natukunda, Julian"

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Factors Influencing Viral Load Suppression Among Adolescents on Antiretroviral Therapy:
(International Health Sciences University., 2016-11) Natukunda, Julian
Introduction Jinja RRH is one of the public health care facilities offering free HIV care and treatment services in Jinja district. In 2015, the hospital started monitoring adolescent outcomes using viral load tests an effort to meet the third 90 of the UNAIDS 90-90-90 strategy. Objective of the study The main objective of the study was to assess the factors influencing viral load suppression among adolescents on ART in Jinja Regional Referral Hospital Methodology A cross sectional study design was used. A total of 238 adolescents on ART who had at least one viral load result recorded in their files at Jinja RRH participated from August to September 2016. Quantitative methods of data collection using a researcher administered questionnaires and Qualitative methods using key informant guide were utilized. Results The independent variables including knowing HIV status categories, getting support from family members, CD4 initiation, counseling evidence and WHO staging were a predictor of viral load suppression among adolescents aged 10-19 years at Jinja Conclusion The proportion of adolescents achieving viral load suppression at Jinja RRH is lower (59%) than the national level 75%. VL suppression among adolescents aged 10-19 years at Jinja RRH ART clinic is predicted by family knowledge of adolescent’s HIV status, getting support from family members, CD4 initiation, counseling evidence and WHO staging. Recommendations Jinja Regional hospital should ensure that counselors work with adolescent and their close family members to ensure successful positive sero status disclosure. The hospital also needs to improve services to be adolescent friendly through age specific triaging and provision of privacy. The MOH and government should ensure Policy guidelines on pre-regimen counseling and adolescent friendly service design are revised and enforced. In addition, viral load testing should be made accessible to all adolescents through an effective referral system.
Virologic failure in HIV-positive adolescents with perfect adherence in Uganda:
(BMC Palliative care, 2019-01-17) Natukunda, Julian; Kirabira, Peter; Ong, Ken Ing Cherng; Shibanuma, Akira; Jimba, Masamine
Background: Adolescents living with human immunodeficiency virus (HIV) die owing to acquired immune deficiency syndrome (AIDS)-related causes more than adults. Although viral suppression protects people living with HIV from AIDS-related illnesses, little is known about viral outcomes of adolescents in sub-Saharan Africa where the biggest burden of deaths is experienced. This study aimed to identify the factors associated with viral load suppression among HIV-positive adolescents (10–19 years) receiving antiretroviral therapy (ART) in Uganda. Methods: We conducted a cross-sectional study among school-going, HIV-positive adolescents on ART from August to September 2016. We recruited 238 adolescents who underwent ART at a public health facility and had at least one viral load result recorded in their medical records since 2015. We collected the data of patients’ demographics and treatment- and clinic-related factors using existing medical records and questionnaire-guided face-to-face interviews. For outcome variables, we defined viral suppression as < 1000 copies/mL. We used multivariate logistic regression to determine factors associated with viral suppression. Results: We analyzed the data of 200 adolescents meeting the inclusion criteria. Viral suppression was high among adolescents with good adherence > 95% (adjusted odds ratio [AOR] 2.73, 95% confidence interval [95% CI, 1.09 to 6.82). However, 71% of all adolescents who did not achieve viral suppression were also sufficiently adherent (adherence > 95%). Regardless of adherence status, other risk factors for viral suppression at the multivariate level included having a history of treatment failure (AOR 0.26, 95% CI, 0.09 to 0.77), religion (being Anglican [AOR 0.19, 95% CI, 0.06 to 0.62] or Muslim [AOR 0.17, 95% CI, 0.05 to 0.55]), and having been prayed for (AOR 0.38, 95% CI, 0.15 to 0.96). Conclusion: More than 70% of adolescents who experienced virologic failure were sufficiently adherent (adherence > 95). Adolescents who had unsuppressed viral loads in their initial viral load were more likely to experience virologic failure upon a repeat viral load regardless of their adherence level or change of regimen. The study also shows that strong religious beliefs exist among adolescents. Healthcare provider training in psychological counseling, regular and strict monitoring of adolescent outcomes should be prioritized to facilitate early identification and management of drug resistance through timely switching of treatment regimens to more robust combinations.