Impact of the integrated community service delivery model on viral re-suppression at Mubende Region Referral Hospital

Introduction: The National Community Health Strategy (NCHS), developed by the Ministry of Health in 2022, underpins the ICSDM. Aligned with the 2022 HIV Guidelines, the NCHS aims to strengthen the HIV response, accelerate the 95:95:95 targets, and achieve AIDS elimination by 2030. At baseline in October 2023, 0% of the non-suppressed clients were enrolled in community-based follow-up, and the viral re-suppression rate among this group stood at 89%. Significant gaps existed in HIV/TB service coordination at household and community levels, with only 57% of the workforce effectively reaching communities. These gaps contributed to missed diagnoses, treatment interruptions, and low viral suppression. The ICSDM addresses these challenges by engaging households, supporting clients with unsuppressed viral loads, providing HIV testing, Advanced HIV Disease management and referrals, thereby improving access to comprehensive health service delivery. Methods: A cohort of 225 non-suppressed clients enrolled between October 2023 and September 2024 was monitored to assess viral re-suppression outcomes after ICSDM enrolment. Each Community Health Worker (CHW) was assigned 5 households to conduct Directly Observed Treatment,Short Course (DOTS) daily for 15 days then weekly to complete a month and monthly follow ups till the repeat Viral Load Testing. All household members were also offered TB screening, HIV testing, and appropriate referrals. Results: Of the 225 clients enrolled, 96% (215/225) achieved viral re-suppression following DOTS. This reflects a significant improvement from the baseline 0% enrolment and 89% re-suppression rates respectively. Conclusion: The ICSDM significantly improved community-level service delivery and achieved high viral re-suppression rates among non-suppressed clients demonstrating its potential to strengthen HIV care.