Evidence map›Paper›PMID 39134343›Full record

ArticleBMJ global health2024

Long-term retention and positive deviant practices in Uganda's community client-led antiretroviral distribution groups (CCLADs): a mixed-methods study.

Julian Natukunda, Keith Baleeta, Junko Kiriya, Ken Ing Cherng Ong, Rogie Royce Carandang, Augustin Muhwezi, Akira Shibanuma, Masamine Jimba

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Article in BMJ global health, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

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4 · The record

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5 · Who and what money

Authors and funding

8 authors.

Julian NatukundaDepartment of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.ORCID http://orcid.org/0000-0002-7541-3999
Keith BaleetaRegional Health Integration to Enhance Services in East Central Uganda Activity (RHITES-EC) Project, University Research Co. LLC, Kampala, Uganda.
Junko KiriyaDepartment of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan jkiriya@m.u-tokyo.ac.jp.
Ken Ing Cherng OngDepartment of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.ORCID http://orcid.org/0000-0001-7196-7671
Rogie Royce CarandangDepartment of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Augustin MuhweziRegional Health Integration to Enhance Services in East Central Uganda Activity (RHITES-EC) Project, University Research Co. LLC, Kampala, Uganda.
Akira ShibanumaDepartment of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.ORCID http://orcid.org/0000-0003-2058-1722
Masamine JimbaDepartment of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.ORCID http://orcid.org/0000-0001-5659-3237

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundHIV testing and starting antiretroviral therapy (ART) are pivotal in treating people living with HIV (PLHIV) but sustaining PLHIV on treatment remains challenging. We assessed retention and attrition in community client-led antiretroviral distribution groups (CCLADs) in Uganda and identified positive deviant practices that foster long-term retention.

methodsUsing explanatory mixed methods, we collected longitudinal medical data from 65 health facilities across 12 districts in East Central Uganda. Quantitative phase, from 18 April 2021 to 30 May 2021, employed survival analysis and Cox regression to assess retention and identify attrition risk factors. Qualitative inquiry focused on four districts with high attrition from 11 August 2021 to 20 September 2021, where we identified nine health facilities exhibiting high retention in CCLADs. We purposively selected 50 clients for in-depth interviews (n=22) or focus group discussions (n=28). Using thematic analysis, we identified positive deviant practices. We integrated quantitative and qualitative findings into joint displays.

resultsInvolving 3055 PLHIV, the study showed retention rates of 97.5% at 6 months, declining to 89.7% at 96 months. Attrition risk factors were lower levels of care (health centre three (adjusted HR (aHR) 2.80, 95% CI 2.00 to 3.65) and health centre four (aHR 3.61, 95% CI 2.35 to 5.54)); being unemployed (aHR 2.21, 95% CI 1.00 to 4.84); enrolment year into CCLAD (aHR 23.93, 95% CI 4.66 to 123.05) and virological failure (aHR 3.41, 95% CI 2.51 to 4.63). Of 22 clients interviewed, 8 were positive deviants. Positive deviants were characterised by prolonged retention in CCLADs, improved clinical outcomes and practised uncommon behaviours that enabled them to find better solutions than their peers. Positive deviant practices included fostering family-like settings, offering financial or self-development advice, and promoting healthy lifestyles.

conclusionsFindings underscore the importance of addressing factors contributing to attrition and leveraging positive deviant practices to optimise retention and long-term engagement in HIV care.

Indexed as

HIV InfectionsAdultAnti-HIV AgentsAnti-Retroviral AgentsFemaleFocus GroupsHumansLongitudinal StudiesMaleMedication AdherenceMiddle AgedQualitative ResearchRetention in CareUgandaAnti-HIV AgentsAnti-Retroviral AgentsEpidemiologyHealth services researchHIVOther study designTreatment

Identifiers

PMID39134343
PMCPMC11331960

What Socratic holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.