Impact of a Treatment Peer-Support Intervention on Linkage and Retention in Long-Term Hepatitis B Care in the West Nile Region of Uganda: An Interrupted Time Series Study

Vollständiger Abstract

Worum geht es in dieser Arbeit?

Background: Strengthening hepatitis B(HBV) linkage and retention in care remains critical to the elimination of population health risks posed by HBV. Yet too few studies have assessed the effectiveness of peer-support-driven HBV care models in enhancing continuity in care in low-resource settings. Methods: We co-designed and evaluated the impact of a treatment peer-support (TPS) intervention on HBV linkage and retention in care at two study sites (Arua and Koboko Hospitals) located in the north-west sub-region of Uganda using a quasi-experimental interrupted time series design and assessed factors related to long-term retention. Results: After TPS intervention, changes in the post-intervention trends of linkage to care of 16.2% (95% CI: 3.3, 29.0) (p = 0.014) and 45.9% (95% CI: 26.1, 65.6) (p < 0.001) were observed for Arua and Koboko respectively. Differences between pre- and post-intervention trends were 11.9% (95% CI: 0.3, 23.5) (p = 0.044) and 34.6% (95% CI: 29.5, 39.7) (p < 0.001) for Arua and Koboko respectively. The post-intervention level change for early retention increased by 6.4% (95% CI: 0.4, 12.4) (p = 0.035) at Arua but not at Koboko (22.8%, 95% CI: −20.9, 66.5) (p = 0.306). At Arua, the TPS intervention correlated with an overall declining trend of −3.9% (95% CI: −5.4, −2.3) (p < 0.001), while at Koboko it correlated with a difference between pre- and post-intervention trends of 0.7% (95% CI: −0.01, 1.4) (p = 0.053). For long term retention, the TPS intervention correlated with a change in post-intervention trend of −1.5% (95% CI: −2.3, −0.7) (p < 0.001) and a difference between pre- and post-intervention trends of −1.4% (95% CI: −2.1, −0.6) (p < 0.001) at Arua hospital. At Koboko hospital, the TPS intervention was associated with a difference between pre- and post-intervention trends of 12.8% (95% CI: 9.8, 15.8) (p < 0.001). In the stratified analysis, early retention was associated with the TPS intervention at Koboko (aPR = 1.16, 95% CI: 1.05, 1.28) (p = 0.004) but not Arua (aPR = 1.01, 95% CI: 0.95, 1.06) (p = 0.771). At Arua hospital, a previous history of HBV treatment predicted early retention in care (aPR = 1.08, 95% CI: 1.05, 1.11) (p < 0.001), whereas at Koboko, a PLHBV having a “treatment buddy” (aPR = 1.21, 95% CI: 1.11–1.33) (p < 0.001), being aged 19–24 years (aPR = 1.39, 95% CI: 1.04, 1.88) (p = 0.026) and being aged 25–34 years (aPR = 1.38, 95% CI: 1.04, 1.83) (p = 0.023) predicted early retention. Conclusions: Innovative interventions are needed to advance linkage to care and shift the trajectory of retention in long-term HBV care, including approaches that target young people living with HBV.