{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T11:10:10Z","timestamp":1756725010335,"version":"3.44.0"},"reference-count":14,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2025,7,4]],"date-time":"2025-07-04T00:00:00Z","timestamp":1751587200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["U01AI100031","U01AI075115","R01AI110324","R01AI102939","R01AI128779","R01AI123002","K01AI125086"],"award-info":[{"award-number":["U01AI100031","U01AI075115","R01AI110324","R01AI102939","R01AI128779","R01AI123002","K01AI125086"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006492","name":"Division of Intramural Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006492","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["AI001040"],"award-info":[{"award-number":["AI001040"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000025","name":"National Institute of Mental Health","doi-asserted-by":"publisher","award":["R01MH090173","R01MH107275"],"award-info":[{"award-number":["R01MH090173","R01MH107275"]}],"id":[{"id":"10.13039\/100000025","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009054","name":"U.S. President\u2019s Emergency Plan for AIDS Relief","doi-asserted-by":"publisher","award":["NU2GGH000817"],"award-info":[{"award-number":["NU2GGH000817"]}],"id":[{"id":"10.13039\/100009054","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["HIV Medicine"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>The antiretroviral therapy (ART) initiation policy in Uganda recommends that ART is initiated on the same day of HIV diagnosis to those who do not have contraindications. We assessed determinants of retention in ART care at the first follow\u2010up (FFU) after same\u2010day ART initiation and retention in long\u2010term care beyond the FFU visit.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a retrospective longitudinal analysis among persons living with HIV aged \u226518\u2009years who initiated ART during April 2016\u2013February 2021 after the inception of Uganda's Test\u2010and\u2010Treat ART policy, which states that \u2018all individuals diagnosed with HIV should initiate ART regardless of clinical stage CD4 count\u2019. Missing the FFU after ART initiation (missing FFU) was defined as not returning for FFU within 1\u2009month of ART initiation; loss to follow\u2010up long\u2010term (LTFU\u2010LT) was defined as delaying more than 3\u2009months to return for a scheduled ART drug refill after the FFU appointment. LTFU\u2010LT time was defined as the time from the FFU visit date to the last follow\u2010up visit date during the study period. We used log\u2010binomial distributions to estimate unadjusted and adjusted relative risks (adjRRs) of missing FFU, and we used Cox proportional hazard models to estimate unadjusted and adjusted hazard ratios (adjHRs) for LTFU\u2010LT.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Overall, 8332 clients initiated ART on the same day of HIV diagnosis. Most were female (55%), aged 25\u201334\u2009years (44%), resided in the semi\u2010urban or rural district (41% and 41%, respectively) and had a median age of 25\u2009years (IQR\u2009=\u200924\u201335). Overall, missing FFU was 15.1%. Increased likelihood\/risk of missing FFU was seen in clients who initiated ART at outreach health service centres versus health facilities (adjRRs\u2009=\u20091.79, 95% CI\u2009=\u20091.6\u20132.0), in younger clients aged 18\u201324\u2009years and 25\u201334\u2009years versus \u226545\u2009years [(adjRRs\u2009=\u20091.65, 95% CI\u2009=\u20091.3\u20132.0) and (adjRRs\u2009=\u20091.31, 95% CI\u2009=\u20091.1\u20131.6), respectively], and clients residing in agrarian districts versus fishing districts (adjRRs\u2009=\u20091.24, 95% CI\u2009=\u20091.1\u20131.4). Overall, the LTFU\u2010LT rate was 25 clients\/100 pys (95% CI\u2009=\u200923.9\u201325.9) and was associated with younger age (18\u201334\u2009years versus \u226545\u2009years, adjHRs\u2009=\u20091.77, 95% CI\u2009=\u20091.5\u20132.1), residence in semi\u2010urban (adjHRs\u2009=\u20091.33, 95% CI\u2009=\u20091.2\u20131.5) or agrarian district (adjHRs\u2009=\u20091.30, 95% CI\u2009=\u20091.2\u20131.5) versus fishing\u2010community district.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Retention\u2010strengthening strategies in tandem with same\u2010day ART initiation efforts for younger clients and clients initiated on ART from mobile and outreach health service settings might improve HIV treatment retention. Best practices for retaining fishing\u2010community clients might improve health outcomes if applied to agrarian and semi\u2010urban communities.<\/jats:p><\/jats:sec>","DOI":"10.1111\/hiv.70064","type":"journal-article","created":{"date-parts":[[2025,7,4]],"date-time":"2025-07-04T06:12:35Z","timestamp":1751609555000},"page":"1367-1374","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Retention outcomes during same\u2010day antiretroviral therapy initiation in health facilities and outreach settings of Rakai, Uganda, 2016\u20132021"],"prefix":"10.1111","volume":"26","author":[{"given":"Jesca","family":"Basiima","sequence":"first","affiliation":[{"name":"Rakai Health Sciences Program  Entebbe Uganda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2609-6525","authenticated-orcid":false,"given":"Victor","family":"Ssempijja","sequence":"additional","affiliation":[{"name":"Rakai Health Sciences Program  Entebbe Uganda"},{"name":"Clinical Monitoring Research Program Directorate Frederick National Laboratory for Cancer Research  Frederick Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anthony","family":"Ndyanabo","sequence":"additional","affiliation":[{"name":"Rakai Health Sciences Program  Entebbe Uganda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Grace Mong","family":"Bua","sequence":"additional","affiliation":[{"name":"Rakai Health Sciences Program  Entebbe Uganda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Denis","family":"Bbaale","sequence":"additional","affiliation":[{"name":"Rakai Health Sciences Program  Entebbe Uganda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Larry W.","family":"Chang","sequence":"additional","affiliation":[{"name":"Rakai Health Sciences Program  Entebbe Uganda"},{"name":"Department of International Health Johns Hopkins Bloomberg School of Public Health  Baltimore Maryland USA"},{"name":"Department of Epidemiology Johns Hopkins Bloomberg School of Public Health  Baltimore Maryland USA"},{"name":"Division of Infectious Diseases, Department of Medicine Johns Hopkins School of Medicine  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Serwadda","sequence":"additional","affiliation":[{"name":"Rakai Health Sciences Program  Entebbe Uganda"},{"name":"Department of Disease Control and Environmental Health Makerere University School of Public Health  Kampala Uganda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph","family":"Kagaayi","sequence":"additional","affiliation":[{"name":"Rakai Health Sciences Program  Entebbe Uganda"},{"name":"Department of Disease Control and Environmental Health Makerere University School of Public Health  Kampala Uganda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arthur G.","family":"Fitzmaurice","sequence":"additional","affiliation":[{"name":"Division of Global HIV &amp; TB, Global Health Center U.S. Centers for Disease Control and Prevention  Kampala Uganda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kate","family":"Grabowski","sequence":"additional","affiliation":[{"name":"Rakai Health Sciences Program  Entebbe Uganda"},{"name":"Department of Pathology Johns Hopkins School of Medicine  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fred","family":"Nalugoda","sequence":"additional","affiliation":[{"name":"Rakai Health Sciences Program  Entebbe Uganda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Godfrey","family":"Kigozi","sequence":"additional","affiliation":[{"name":"Rakai Health Sciences Program  Entebbe Uganda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ronald","family":"Gray","sequence":"additional","affiliation":[{"name":"Rakai Health Sciences Program  Entebbe Uganda"},{"name":"Department of Epidemiology Johns Hopkins Bloomberg School of Public Health  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria","family":"Wawer","sequence":"additional","affiliation":[{"name":"Rakai Health Sciences Program  Entebbe Uganda"},{"name":"Department of Epidemiology Johns Hopkins Bloomberg School of Public Health  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gertrude","family":"Nakigozi","sequence":"additional","affiliation":[{"name":"Rakai Health Sciences Program  Entebbe Uganda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steven J.","family":"Reynolds","sequence":"additional","affiliation":[{"name":"Rakai Health Sciences Program  Entebbe Uganda"},{"name":"Division of Infectious Diseases, Department of Medicine Johns Hopkins School of Medicine  Baltimore Maryland USA"},{"name":"Division of Intramural Research, National Institute of Allergy and Infectious Diseases National Institutes of Health  Bethesda Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,7,4]]},"reference":[{"volume-title":"Edited by Health","year":"2016","author":"UgandaMinistryofHealth","key":"e_1_2_11_2_1"},{"key":"e_1_2_11_3_1","unstructured":"UNAIDS.UNAIDS Fact Sheet of Global HIV statistics 2020.2020."},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-016-2972-6"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13690-020-00473-4"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwab032"},{"volume-title":"Consolidated guidelines for the prevention and treatment of HIV and AIDS in Uganda","year":"2016","author":"MoH","key":"e_1_2_11_7_1"},{"key":"e_1_2_11_8_1","unstructured":"Ministry of Heath U.Uganda patient medical records system \u2013 UgEMR.Uganda Ministry of Health.https:\/\/emrportal.mets.or.ug\/"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/jia2.25529"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0192403"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1003646"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0104961"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2017-016800"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0000000000001250"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0000000000002942"}],"container-title":["HIV Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/hiv.70064","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T10:45:14Z","timestamp":1756723514000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/hiv.70064"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,4]]},"references-count":14,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2025,9]]}},"alternative-id":["10.1111\/hiv.70064"],"URL":"https:\/\/doi.org\/10.1111\/hiv.70064","archive":["Portico"],"relation":{},"ISSN":["1464-2662","1468-1293"],"issn-type":[{"type":"print","value":"1464-2662"},{"type":"electronic","value":"1468-1293"}],"subject":[],"published":{"date-parts":[[2025,7,4]]},"assertion":[{"value":"2024-12-23","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-05-21","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-07-04","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}