title: Evaluating facility-based antiretroviral therapy programme effectiveness: a pilot study comparing viral load suppression and retention rates.
abstract: Increased demand for antiretroviral therapy (ART) services combined with plateaued levels of development assistance for HIV/AIDS requires that national ART programmes monitor programme effectiveness. In this pilot study, we compared commonly utilised performance metrics of 12- and 24-month retention with rates of viral load (VL) suppression at 15 health facilities in Uganda.
  
  
  
  Retrospective chart review from which 12- and 24-month retention rates were estimated, and parallel HIV RNA VL testing on consecutive adult patients who presented to clinics and had been on ART for a minimum of six months. Rates of VL suppression were then calculated at each facility and compared to retention rates to assess the correlation between performance metrics. Multilevel logistic regression models predicting VL suppression and 12- and 24-month retention were constructed to estimate facility effects.
  
  
  
  We collected VL samples from 2961 patients and found that 88% had a VL ≤1000 copies/ml. Facility rates of VL suppression varied between 77% and 96%. When controlling for patient mix, a significant variation in facility performance persisted. Retention rates at 12 and 24 months were 91% and 79%, respectively, with a comparable facility-level variation. However, neither 12-month (ρ = 0.16) nor 24-month (ρ = -0.19) retention rates were correlated with facility rates of VL suppression.
  
  
  
  Retaining patients in care and suppressing VL are both critical outcomes. Given the lack of correlation noted in this study, the utilisation of VL monitoring may be necessary to truly assess the effectiveness of health facilities delivering ART services.
authors.affiliation: Division of Emergency Medicine, University of Washington, Seattle, WA, USA.|Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
authors.forename: Herbert C
authors.initials: HC
authors.lastname: Duber
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
authors.forename: D Allen
authors.initials: DA
authors.lastname: Roberts
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.|Infectious Diseases Research Collaboration, Makerere University, Kampala, Uganda.
authors.forename: Gloria
authors.initials: G
authors.lastname: Ikilezi
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
authors.forename: Nancy
authors.initials: N
authors.lastname: Fullman
authors.affiliation: African Leaders Malaria Alliance, Kampala, Uganda.
authors.forename: Anne
authors.initials: A
authors.lastname: Gasasira
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
authors.forename: Emmanuela
authors.initials: E
authors.lastname: Gakidou
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
authors.forename: Annie
authors.initials: A
authors.lastname: Haakenstad
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
authors.forename: Aubrey
authors.initials: A
authors.lastname: J Levine
authors.affiliation: Infectious Diseases Research Collaboration, Makerere University, Kampala, Uganda.
authors.forename: Jane
authors.initials: J
authors.lastname: Achan
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D003695:Delivery of Health Care / Q000592:standards*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006268:Health Facilities; D006296:Health Services / Q000592:standards*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010352:Patient Dropouts; D010865:Pilot Projects; D015397:Program Evaluation; D012189:Retrospective Studies; D014454:Uganda; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents
keywords: Afrique subsaharienne; HIV; VIH; antiretroviral therapy; delivery of care; entrega de atención sanitaria; prestation des soins de santé; sub-Saharan Africa; terapia antirretroviral; traitement antirétroviral; África subsahariana