BACKGROUND: Uganda continues to be a world leader in successfully engaging its HIV-affected and -infected communities in HIV program quality improvement. Atuhura et al. 2017 demonstrated that the community score card (CSC) effectively enables communities to advocate for such improvement. CSC findings have revealed community demand for adherence clubs to support viral load (VL) suppression among HIV-positive men who have sex with men (MSM).
DESCRIPTION: A retrospective observational evaluation of 2017-2018 Spectrum data across 8 facilities representing 3 regions reported that, of the 126 MSM enrolled on ART, only 15 (11.9%) had VL suppression. Between January 2018 to March 2019, clinicians screened 145 MSM, of whom 71 (49.0%) were eligible (VL suppression at screening, on ART for '¥1 year) to join adherence clubs. In this same timeframe, 10 adherence clubs (each consisting of 4 to 11 participants) were formed across the country. Each club's healthcare workers (HCWs) received gender and sexual diversity training, performed medical check-ups, refilled ART, and offered HIV care counseling. Participants were followed monthly from January 2018 through November 2019. The last VL test in November 2019 reported VL suppression among these 71 MSM was 100%.
LESSONS LEARNED: To our knowledge, this is the first time that adherence clubs have been demonstrated to enhance treatment compliance and retention in care among MSM in Uganda. HIV-positive clients, particularly key populations (KP), who continue to experience stigma and discrimination reported overwhelming support for these adherence clubs because accompanying healthcare workers were friendly and compassionate. Members agreed that monthly gatherings were an optimal frequency and qualitative data reveals that clients have reported increase in general confidence, ability to speak openly about their HIV status, and desire to mobilize their HIV-positive peers to strive for treatment adherence and VL suppression. Overall, communities have reported greater ownership and investment into reaching HIV epidemic control.
CONCLUSIONS: ART adherence clubs will continue to expand for MSM clients and will be introduced to other KP groups. Successes with adherence clubs and other community engagement activities (e.g., CSC) continue to underscore the importance of recognizing the community as a critical stakeholder in the fight against HIV.