Clinical management of patients with advanced HIV disease at The AIDS Support Organization, Mbarara clinic in Southwestern Uganda: a retrospective review of patient records

Introduction : Uganda has made significant progress in expanding access to ART over the years, however, currently up to 50% of PLHIV still enroll into HIV care with AHD. PLHIV who present with AHD continue to have a greater mortality risk and the risk rises as CD4 counts drop, particularly if they fall below 100 cells per cubic millimeter. This study therefore seeks to evaluate the clinical management practices for AHD at a high volume not for profit health facility in an urban setting in Southwestern Uganda. Methods : A cross-sectional analysis of secondary data from a large volume, nonprofit health facility in Southwestern Uganda was done. An analysis included patient records of 994 new and 76 virologically non suppressed patients. Descriptive analysis of data was done, and the two groups (treatment naïve and non-suppressed) were compared using chi-square tests or Fisher’s exact test for categorical data and the Mann Whitney U test for numerical data. The analysis was done using StatsDirect. Results : The prevalence of ADH as defined by a CD4 cell count below 200 cells/µl or WHO clinical stage 3 or 4 disease was 20.4% (95% CI: 18.0—23.0). The prevalence of AHD was considerably higher among males 30.3% (95% CI: 26.1—35.0%) compared to females: 13.9% (95% CI: 11.2—17.0%). Access to CD4 as a diagnostic test for AHD was 74.5% (741/994) among newly enrolled patients compared to 77.6% (59/76) among virally non suppressed patients. Access to serum CrAg screening among patients with AHD was higher among the newly enrolled HIV clients at 60.6% (131/216) compared to non-suppressed clients; 22.2% (6/27) (p < 0.001). Additionally, there was no significant difference in administration of fluconazole between the two groups (p = 0.476). Among the patients with AHD, the proportion of patient tested for TB using urine TB_LAM was higher among the newly enrolled patients (45.9%) compared to the non-suppressed clients (21.4%), and this difference was statistically significant (p = 0.010). Conclusion : This study demonstrates that much as significant strides have been made in the achievement of the UNAIDS 95 95 95 targets, the prevalence of AHD remains high, and the implementation of the AHD intervention package remains sub-optimal. The Ministry of Health and partners need to strengthen processes for the screening, diagnosis, and management of AHD. Clinical trial number: Not applicable.