BACKGROUND: The Ugandan HIV treatment guidelines recommend the Advanced HIV Disease (AHD) package of care (PoC) for all new clients diagnosed with HIV and those failing on their antiretroviral treatment (ART). This study compares access to some components of the AHD PoC and the testing outcomes between newly diagnosed people living with HIV (PLHIV) and existing clients who are failing their ART.
DESCRIPTION: The Uganda Ministry of Health (MOH) with support from partners rolled out the AHD PoC in 2021 after completing healthcare worker training and delivery of commodities to health facilities. Interventions included CD4 testing to identify AHD clients; screening for opportunistic infections (OIs); prophylaxis and treatment for OIs; and rapid ART initiation. After two years of implementation, we abstracted and compared data from DHIS2 on AHD service uptake among new clients and those failing their ART from January to December 2023 to identify and address any gaps along the AHD cascade in these two client populations.
LESSONS LEARNED: Access to CD4+ testing was higher (84%) among the new clients compared to the failing clients (57.3%). While access to TB-LAM testing was also better among the new clients with AHD compared to the failing clients, a greater proportion of the failing clients received CrAg testing. On testing outcomes, AHD prevalence and TB-LAM positivity among new clients is marginally higher than the failing clients. However, blood CrAg positivity was slightly higher among failing clients than new clients. The prevalence of OIs is comparable between new clients and failing clients, hence optimizing AHD interventions among failing clients presents a huge opportunity to save more lives from AHD-associated OIs.


CONCLUSIONS: Deprioritizing AHD services among failing clients results in missed opportunities to identify and manage life-threatening OIs. Country programs need to ensure equitable access to AHD interventions among failing clients to further reduce AIDS morbidity and mortality.