Assessing HIV clinics outcome and factors associated: adults- patients enrolled in program at least ten years in Rural settings, cross-sectional study, Rwanda

Abstract

Background HIV is pandemic issue as it is among top cause morbidity and mortality globally especially in low and middle income countries. It is also problematic because all people who are HIV+ don’t know their status, not all people living with HIV enrolled in program, and also all patients in program don’t increase their CD4. Rwanda had done significant improvement through decentralizing HIV care to health centers, HIV integration in other programs and many others. Also, HIV prevalence remains consistent over 10 years. Despite all those interventions HIV remains a public health problem and it is always on table. There is limited information on HIV program outcomes and associated factors in Rwanda. The study aims at assessing HIV program outcome and factors associated with the outcome. Methods Secondary data from Electronic Medical Record collected were: baseline, and most currently CD4, BMI, Viral load. Primary data were collected from patients after consenting. Before collecting data, tools were validated and tested. During collection of data privacy and confidentiality were ensured, and there was no harm to participant as voluntary and no direct benefit to participants. Data were managed in excel spreadsheet, analyzed in STATA and numerous tests such as T-test, Chi, and logit were used to measure outcomes and factors associated with outcome. Study approval was obtained from IRB. Results Findings show that there were positive CD4 trends as 81% of patients increased CD4 (before and after) whereas 19% did not increase. Moreover 73% are over 500 CD4 standards whereas 13% were under 500 CD4. No educated patients were less likely in increase CD4 (OR: 0.54, CI: 0.35, 0.98, pv-0.006). Furthermore patients from Kabarondo HC are less like to increase CD4 (OR: 0.19, CI: 0.39, 0.98, pv-0.04). Also, patients who have knowledge on balanced diet were 7.9 times likely to increase CD4 compared to those without diet knowledge (OR: 7.9, CI: 2.33, 9.09, Pv: 0.004). Lastly, patients moderately satisfied were less like to increase CD4 (OR: 0.10, CI: 0.01, 0.62, pv-0.01. Conclusion The assessment of HIV program through CD4 increase and factors associated showed high increase in CD4 as 81% of patients increased their CD4 count and 73% of all patients were over 500 CD4 standards. Level of education, health facility where patients receive care, knowledge on balanced diet, and satisfaction of health services were associated with CD4 increase in this study.