Evaluating the contribution of operation triple zero to HIV viral load suppression and retention among the adolescents in TASO Uganda using RE-AIM framework: a before and after implementation science study.

Abstract

Introduction: Adolescents living with HIV (ALHIV) aged 10-19 years endure sub-optimal viral load suppression (VLS) and retention in care in many settings. We implemented operation triple zero (OTZ) in The AIDS Support Organization (TASO) Soroti and Mbale Centers of Excellence (COEs) to improve VLS and retention. Thus, this study evaluated the contribution of OTZ to improving both treatment outcomes among the ALHIV in the two COEs at one year.

Methodology: This before and after study used Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework to guide secondary data collection from the cohort of ALHIV active in care in the April-June 2022 quarter. Effectiveness was determined by computing the overall VLS rates basing on plasma RNA copies below 1000/ml while retention was based on being active in care at the end of June 2024. A self-report was used to gather fidelity data. Univariates were summarized as frequencies and proportions, Generalized Equation Estimate (GEE) to compute the effect of the model and associated factors at 95% confidence interval and P < 0.05 level of significance. Odds ratio was used to report levels of predictability.

Results: Out of the original 533 ALHIV, 510 were considered for the post-intervention analysis, 53.1% females, mean age of 15.27 (Standard deviation = 2.15). Overall, retention at 12 months improved from 95.9 to 97.3% while VLS from 84 to 92.7% [adjusted OR 1.26 95%CI (0.61-2.61) P = 0.036]. Importantly, there was zero death in the one year of implementation. After adjusting for confounders, adolescents in the facility-based group (FBG) were more likely to be retained in care [adjusted odds ratio (aOR)7.36 95% CI (2.35-23.10) P = 0.001]. Also, multi-month dispensing [aOR 11.65 95%CI (2.93-46.34) P < 0.001] and being in FBG [aOR 9.87 95%CI (4.08-23.88) P < 0.001] and community-based models [aOR 21.96 95%CI (2.68-179.84) P = 0.004] were predictive of good VLS while poor adherence [aOR 0.02 95%CI (0.0037-0.11) P < 0.001] and being male [aOR 0.5 95%CI (0.27-0.91) p = 0.024] were predictors of poor VLS. Fidelity was good, at 80%.

Conclusions: OTZ contributed to improved VLS in the setting possibly due to fidelity of enhanced implementation of adolescent friendly health services. We encourage OTZ adaptation in similar settings to strengthen improvements in VLS.