HIV clinical stage progression of patients at 241 outpatient clinics in DRC: Disparities by gender, TB status and rurality

Presentation given at APHA Annual Meeting and Expo.

Background:

HIV clinical care programs are increasingly customizing services to patients’ clinical stage progression (WHO’s four-tiered staging). Understanding factors associated with Persons Living with HIV (PLHIV)’s stage progression is essential for patient-centered services.

Methods:

To analyze PLHIV on antiretroviral therapy (ART) patients’ characteristics associated with progression stages, we used data, from 1/2014--6/2019, from 49,460 ART patients from 241 outpatient clinics in 23 health zones in Haut-Katanga and Kinshasa provinces, Democratic Republic of Congo. Chi-square and multinomial logistic regression assessed bivariate and multivariate associations.

Results:

ART patients were stage 4 (4.4%) and stage 3 (30.7%), with less severe stages 2 (22.9%) and 1 (41.9%). After covariate control, patients without TB were more likely than those with TB (p40.37 months); for ART duration < 3.23 months the AOR was 2.47, for 3.23-14.52 months it was 2.60, and for 14.53-40.37 months it was 1.77 (quartile cut-points used). Compared to patients in urban health zones, those in rural (AOR, 0.32) and semi-rural zones (AOR, 0.79) were less likely to be stage 1.

Conclusion:

Significant variations in progression stage by location and demographic characteristics are indicative of the need for targeted efforts to improve HIV care. TB/HIV co-infected patients’ great risk of being stage 3 or 4 implies a particular need for customized approaches for this population.