Major Clinical and Non Clinical Determinants predicting therapy naivete of MSM: Lessons for STI/HIV initiatives in Uganda

Muyunga Thomas, Ssegirinya Musisi, Besigye Richard, Kwizera Micheal, Nayiga Ssewaali, Aida Keisha, Eria Kamya.

BACKGROUND:

This study of two groups randomized 109 human immunodeficiency virus (HIV)-infected patients with CD4+ cell counts >350 cells/microL to intermittent antiretroviral therapy (ART; the drug conservation [DC] group) versus continuous ART (the viral suppression [VS] group). A drug conservative (DC) group, for participants starting ART when the CD4+ cell count was <250 cells/microL. The DC group is for those identified after vigorous outreach programmes. The VS is for those who initiated own HIV Counselling and Testing (HCT).  Clinical outcomes in participants not receiving ART at entry inform the early use of ART.

METHODS:

Patients who were either ART naive (n=29) or who had not been receiving ART (n=28) were analyzed. The following clinical outcomes were assessed: (i) opportunistic disease (OD); (ii) OD (fatal or nonfatal); (iii) serious non-AIDS events ( SRH-commodities, malaria, TB, nutrition issues, lack of taxi-fares, battering, physical bruises, anal inflammation, STIs, cardiovascular, renal, and hepatic disease plus non-AIDS-defining cancers); (iv) discrimination and stigma (v) the composite of outcomes (i), (iii) and (iv) and (vi) the composite of outcomes (ii) and (iii).

RESULTS:

A total of 57 participants (28 in the DC group and 29 in the VS group) were followed (mean, 18 months). For outcome (v) 52 events occurred in DC and 13 events in VS.  For outcome (vi), 23 events occurred in the DC (3 in ART-naive participants and 20 in those who had not received ART) and VS (1 in ART-naive participants and 2 events in those who had not received ART) groups, respectively.

CONCLUSIONS:

Early reporting for health care by MSM informs on Initiation of and appropriateness of STI/HIV-related services may reduce both OD and serious non-AIDS events.