Feasibility of a Pilot Communication Intervention to Promote Linkage to HIV Clinic After Routine HIV Testing in Nakivale Refugee Settlement in Uganda

Abstract

Background: In Nakivale Refugee Settlement, 54% of newly diagnosed HIV-infected clients link to HIV clinic. We evaluated the efficacy of a communication intervention on linkage to care. Methods: From November 2014-July 2016, clients undergoing HIV testing in Nakivale were offered a communication intervention. Mobile phone access was required to participate. Enrolled clients were phoned weekly (up to 3 calls/week) to encourage clinic attendance; clients who could read also received weekly text message reminders. The primary outcome was an initial HIV clinic visit within 90 days. We used two-sample t test with equal variances and Pearson’s chi-square test to evaluate characteristics of those willing to participate. Results: Of 5,586 clients undergoing HIV testing, 2,901 (52%) were willing to participate in the communication intervention. Willingness to participate was higher among males than females (67% vs 37%, p<0.001), Ugandan nationals than refugees (58% vs 49%, p<0.001); and those living closer than further to clinic (average time to clinic 49min (CI 48-51) vs. 68min (CI 66-70), p<0.001). Of those who did not participate, 2,470 (92%) reported the reason was lack of phone access. Of 209 HIV-infected clients, 102 (49%) eligible individuals participated; 48 (47%) were literate and received text messages. There was no difference in linkage to clinic within 90 days of HIV testing between the intervention and non-intervention groups (49% vs 51%, p=0.973). Excluding clients who linked prior to the intervention (n=81), there was a trend toward increased linkage in the intervention group (61% vs 39%, p=0.162). Conclusion: In Nakivale Refugee Settlement, males, Ugandan nationals and those living closer to clinic were more willing to participate in a communication intervention. Poor access to phones limited enrollment. Low literacy among participants restricted use of text messages. Nonetheless, the pilot communication intervention suggested a trend toward improved linkage to an initial HIV clinic visit.