A cross-sectional study evaluating the screening, diagnosis and management of advanced HIV disease at the AIDS support organization service centre in Mbarara City, Southwestern Uganda.

Introduction: Uganda has made significant progress in expanding access to ART over the years, however, currently up to 50% of People Living with HIV still enroll into HIV care with Advanced HIV Disease (AHD). This study therefore seeks to evaluate the screening, diagnosis and treatment of AHD at a high volume not for profit health facility in an urban setting in Southwestern Uganda.

Methods: A cross-sectional study utilizing secondary data from a high volume, nonprofit health facility in southwestern Uganda was conducted from April 2022 to August 2022. The analysis included patient records for 994 newly diagnosed individuals and 76 patients who were not virologically suppressed. A descriptive analysis of the data was conducted, and the two groups (newly diagnosed and non-suppressed) were compared using chi-square tests or Fisher's exact test for categorical data, as well as the Mann Whitney U test for numerical data.

Results: The prevalence of AHD as defined by a CD4 + cell count below 200 cells/mm³ or WHO clinical stage 3 or 4 disease was 21.7% (216/994). The prevalence of AHD was considerably higher among males (32.5%) compared to females (13.9%) (p value < 0.001). CD4 + testing for AHD was at 74.5% (741/994) among newly enrolled patients compared to 77.6% (59/76) among virally non suppressed patients (p = 0.822). Serum CrAg testing 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 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 implementation strategies to improve the screening, diagnosis, and management of AHD.