Effect of Active Follow-Up on Viral Load Suppression among People Living with HIV on Intensive Adherence Counseling in Uganda: An Instrumental Variable Analysis

We assessed the effect of active follow-ups on viral load (VL) suppression among people living with HIV (PLWH) who had missed their clinic visit(s) and were receiving intensive adherence counseling (IAC) at a large referral hospital in mid-western Uganda. We designed a quasi-experimental study, using a locator map (a local map showing residence) as an external factor (instrumental variable) that influenced active follow-up. We performed instrumental variable analysis. Of the 165 participants included, 24.8% had a client locator map, and possessing a map was associated with active follow-up (F-statistics 53.1; P <0.0001). Active follow-up did not significantly improve VL suppression at varying cutoffs, namely <1,000 copies/ml (P = 0.607), less than 200 copies/ml (P = 0.684), and less than 50 copies/ml (P = 0.435). Although active follow-up did not significantly improve VL suppression among PLWH on IAC, it showed a modest trend toward improvement. Large, randomized trials are needed.