Evaluating the contribution of Operation triple zero to HIV viral load suppression and retention among the adolescents in TASO Uganda using RE-AIM framework: a before and after implementation science study

Evaluating the contribution of Operation triple zero to HIV viral load suppression and retention among the adolescents in TASO Uganda using RE-AIM framework: a before and after implementation science study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Evaluating the contribution of Operation triple zero to HIV viral load suppression and retention among the adolescents in TASO Uganda using RE-AIM framework: a before and after implementation science study Bonniface Oryokot, Abraham Ignatius Oluka, David Kagimu, Yunus Miya, and 9 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5883059/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 20 May, 2025 Read the published version in AIDS Research and Therapy → Version 1 posted 8 You are reading this latest preprint version Abstract Introduction Adolescents living with HIV (ALHIV) aged 10–19 years endure sub-optimal viral load suppression (VLS) and retention in care in many settings. We implemented operation triple zero (OTZ) in The AIDS Support Organization (TASO) Soroti and Mbale Centers of Excellence (COEs) to improve VLS and retention. Thus, this study evaluated the contribution of OTZ to improving both treatment outcomes among the ALHIV in the two COEs at one year. Methodology This before and after study used Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework to guide secondary data collection from the cohort of ALHIV active in care in the April-June 2022 quarter. Effectiveness was determined by computing the overall VLS rates basing on plasma RNA copies below 1000/ml while retention was based on being active in care at the end of June 2024. A self-report was used to gather fidelity data. Univariates were summarized as frequencies and proportions, Generalized Equation Estimate (GEE) to compute the effect of the model and associated factors at 95% confidence interval and P < 0.05 level of significance. Odds ratio was used to report levels of predictability. Results Out of the original 533 ALHIV, 510 were considered for the post-intervention analysis, 53.1% females, mean age of 15.27 (Standard deviation = 2.15). Overall, retention at 12 months improved from 95.9–97.3% while VLS from 84–92.7% [adjusted OR 1.26 95%CI (0.61–2.61) P = 0.036]. Importantly, there was zero death in the one year of implementation. After adjusting for confounders, adolescents in the facility-based group (FBG) were more likely to be retained in care [adjusted odds ratio (aOR)7.36 95% CI (2.35–23.10) P = 0.001]. Also, multi-month dispensing [aOR 11.65 95%CI (2.93–46.34) P < 0.001] and being in FBG [aOR 9.87 95%CI (4.08–23.88) P < 0.001] and community-based models [aOR 21.96 95%CI (2.68-179.84) P = 0.004] were predictive of good VLS while poor adherence [aOR 0.02 95%CI (0.0037-0.11) P < 0.001] and being male [aOR 0.5 95%CI (0.27–0.91) p = 0.024] were predictors of poor VLS. Fidelity was good, at 80%. Conclusions OTZ contributed to improved VLS in the setting possibly due to fidelity of enhanced implementation of adolescent friendly health services. We encourage OTZ adaptation in similar settings to strengthen improvements in VLS. Operation Triple Zero Viral Load suppression retention adolescents RE-AIM TASO Introduction The World Health Organization (WHO) recommends HIV RNA viral load testing as the gold standard for monitoring response to antiretroviral therapy (ART) [ 1 , 2 ] among the people living with HIV (PLHIV). HIV RNA Viral load (VL) is classified as suppressed if below 1000 RNA copies/ml and non-suppressed if above that in most programs. Achieving sustained suppressed viral load is the ultimate goal of ART and a precursor to reaching the epidemic control by 2030. In 2023, 93% of all people living with HIV (PLHIV) and on ART had suppressed their viral load across the globe, still below the 95% target by 2025. Despite this progress among the general population, only 48% of children and adolescents aged below 15 years had attained VL suppression [ 3 ]. Indeed, adolescents living with HIV aged 10–19 years continue to lag and a recent systematic review reported a VL suppression rate of 55% in sub-Saharan Africa, including Uganda [ 4 ]. In Uganda, recent findings indicate viral load suppression and retention among children and adolescents living with HIV (CALHIV) of 80% and 87% respectively [ 5 ]. Another study reported a 12-month retention among the youth aged 15–24 years old of 65.7% and Izudi reported 90% following a quality improvement intervention in one facility [ 6 , 7 ]. Further, Maena et al. reported viral load suppression among the adolescents of 69%, and a more recent study found an 81% rate in Uganda’s Kabale district [ 8 , 9 ]. All these indicate sub-optimal retention and viral load suppression rates of less than the expected 95%. To attain sustained VL suppression, adolescents living with HIV (ALHIV), aged 10–19 years, need to remain in care and adhere well. This requires programs to implement adolescent health friendly services such as peer driven approaches that include the community adolescent treatment support (CATS) of Zimbabwe, the Youth and Adolescent Peer Supporters (YAPS) in Uganda and the operation triple zero in Kenya [ 10 – 12 ]. Uganda has implemented the YAPS model to improve retention and viral load suppression among the adolescents and young people living with HIV (AYPLHIV) since 2019. The YAPS are aged 18–24 years, overcame internal stigma, able to read and write in English [ 13 ]. In addition, other modalities such as differentiated service deliver models including community drug delivery points, treatment optimization with Dolutegravir (DTG) and multi-month dispensing have also been implemented to improve treatment outcomes [ 14 ]. Unfortunately, both retention and VL suppression remain sub-optimal in Uganda. In The AIDS Support Organization (TASO) Soroti and Mbale centers of excellence, viral load suppression was at 84%, far below the expected 95% target, and one year retention rate of 96% among the ALHIV [ 15 ]. This sub-optimal VL suppression rate necessitated a re-imagination of the current approach to adolescent peer support services. As per the success of the operation triple zero (OTZ) [ 12 , 16 ] elsewhere, it was considered for implementation in TASO Soroti and Mbale COEs. As detailed in the protocol, OTZ aims to achieve zero missed appointment, zero missed pill and zero viral load among the adolescents and young people living with HIV [ 11 , 16 – 18 ]. This asset-based model aims at improving the health of AYPLHIV by making them active participants of creating optimal health strategies through a multidisciplinary undertaking. The model entails empowering the adolescents and young people living with HIV, health workers and caregivers using their respective packages as provided for in the national guidelines. The package for caregivers offers basic knowledge about HIV and how to groom an adolescent and young person while that for health workers includes training on the comprehensive ministry of health package for the same population. Finally, the AYPLHIV are provided with basic information about HIV, living positively with HIV and other coping mechanisms [ 11 ]. The typical implementation involves quarterly caregiver meetings and monthly meetings of the AYPLHIV led by the OTZ champions which can take place both in the facility and community [ 12 , 19 ]. This study thus evaluated the one-year contribution of OTZ to improving VL suppression and retention among the sub-population in the TASO setting. The Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework of implementation science was used to guide the evaluation [ 20 ]. The findings provide further insights toward scaling up of the model in similar settings. Methodology Study Design This was a before and after study design. We compared both retention and viral load suppression among the ALHIV before the implementation of OTZ and twelve months after the intervention. A formative approach was employed in this implementation science, from July 2023 to June 2024. Supported by the consolidated framework for implementation research (CFIR) [ 21 ], we conducted a mixed methods study to identify barriers and facilitators to retention and viral load suppression among the adolescents living with HIV (ALHIV) in the setting. These enabled the research team to adapt the operation triple zero (OTZ) to fit the context, using ADAPTIT framework [ 22 – 24 ]. The adaptation plan was collectively developed with the facility teams, and documented using framework for reporting adaptations and modifications (FRAME) [ 25 ]. Facility teams were oriented on the implementation of OTZ and standard operating procedures developed to guide health workers. Study Setting The study was conducted in The AIDS Support Organization (TASO) centers of excellence, Mbale and Soroti, home to more than 13,000 PLHIV as detailed in the protocol [ 17 ]. The two COEs provide comprehensive HIV services including prevention, care and treatment interventions to children, adolescents and adults. Both COEs are east of Kampala, capital city, approximately, 224 and 324 kilometers away, respectively. Each COE serves people living with HIV who come from at least 23 districts, a radius of 75 kilometers. Study Population Adolescents living with HIV aged 10–17 years of age who were active in care in the April-June 2022 quarter. These were followed up longitudinally to establish their status for retention and viral load suppression at 12 months before and after the intervention. Sample Size Estimation and Sampling Techniques We used a census to enroll all the ALHIV who were active in care during the April-June 2022 quarter for the analysis. The Intervention Description General overview A multi-disciplinary team composing of a clinician, counsellor and peer (leveraged the YAPS) was oriented on the adapted OTZ model for one day. The orientation included a refresher on Uganda 2022 national consolidated guidelines service package for ALHIV [ 14 ], communicating with adolescents, and how to nurture adolescents. The adapted components of OTZ included monthly engagement of adolescents with non-suppressed viral load, quarterly literacy sessions with caregivers of the ALHIV with high viral load, and other clinical services as required. These sessions were differentiated to both facility and community. During the engagements, the teams offered respective packages to the two groups, empowering them to take more responsibilities in improving the health outcomes of the ALHIV. To support the health workers, standard operating procedures were developed and users were mentored to use them appropriately. Engagement with ALHIV During the monthly engagements, each adolescent was empowered to come up with a written personal health improvement plan, and this was filed for future reference. The monthly meetings were championed by the peers who led various activities including treatment literacy sessions, sharing experiences among the adolescents to build each other’s self-esteem and empowering the clients to have a positive outlook into life. The peers also conducted pre-appointment reminders, follow-up of those who missed their appointment and community-based adherence support. Further, adolescents were also provided with financial literacy sessions, and in collaboration with Mbale Network of Young People Living with HIV/AIDS (MNYPA), trained 21 out of school adolescents with basic skills such as liquid soap making. To strengthen the implementation further, bi-weekly check-in by the research team and monthly by the technical team from International Pediatric HIV/AIDS Symposium in Africa (IPHASA) to offer additional guidance were conducted. Lastly, continuous quality improvement was also integrated into the intervention as well to ensure adequacy of the implementation. The caregiver engagement There were two caregiver meetings. The caregivers of ALHIV with unsuppressed viral load were gathered in one place (both facility and community) and provided with basic information about HIV including its transmission and management; adherence to ART, disclosing HIV status to an adolescent, stigma and discrimination, sexual and reproductive health issues and how to empower an adolescent to lead an independent life. Data Management Data Collection Evaluation Framework We used Reach, Effectiveness, Adoption, Implementation Maintenance (RE-AIM) framework to determine the variables to collect. RE-AIM is a popular implementation science framework that helps standardize program evaluation data collection and it states that interventions are impactful if effective evidence-based intervention reaches a wide proportion of the public, through adoption by willing entities, implemented as intended and maintained over time [ 20 , 26 – 28 ]. The model has been used elsewhere to evaluate programs such as integration of methadone into ART in Tanzania, economic empowerment interventions as HIV prevention programs among adolescent girls and young women in sub-Saharan Africa, and the continuum of care management in Brazil [ 27 , 29 , 30 ]. In this study, we used Reach, Effectiveness and Implementation dimensions to guide the evaluation of OTZ program. The three dimensions were best suited to guide data collection required to answer the research questions and the others (adoption and maintenance) were irrelevant to the current study, hence not considered. Table 1 summarizes the dimensions of RE-AIM used to guide measurement of the primary outcomes. Table 1: Dimensions of RE-AIM used to measure primary outcomes. Dimension Description Reach Proportion of adolescents living with HIV who were enrolled into the model Effectiveness Proportion of individuals with HIV viral RNA copies of less than 1000/ml. Retention: Proportion of adolescents who were active in care by the end of June 2024. This was categorized into active (if ALHIV had their most recent clinic encounter is at least 28 days within the next scheduled appointment), transferred out for those who moved to other facilities, dead for those who died and lost for those who had no clinic contact for at least 28 days their last scheduled appointment. Implementation Fidelity (extent of the implementation of the adapted model). Fidelity is the extent to which an intervention is implemented as planned [25]. We used self report and observation to collect data on fidelity, basing on the adaptation plan developed at the start of the implementation of OTZ. We used the same questionnaire as at baseline to collect post-implementation data as well. A virtual re-orientation of the data collection team was done prior. Data collection was done using Kobo collect, version 2.024.19. The variables included: Age, viral load status, ART status, HIV status disclosure status, school going status, differentiated service delivery model, presence of caregiver and Tuberculosis (TB) status. For fidelity, self-report was used to collect data on some of the key implementation components basing on the adaptation plan. Three dimensions of adherence, dosage and quality of the implementation were considered. Each core component of OTZ was assigned one point except monthly OTZ meetings which received two marks. Arbitrarily, a score of below 50% was considered poor; 50–79%, fair and 80%+, good fidelity. Given that the two sites are generally similar and thus variation in implementation was negligible, overall fidelity was considered. Data Analysis Univariate analysis was reported as frequencies and proportions. The Generalized Estimating Equations (GEE) approach was used to build the multivariate model, a method suitable for analysing clustered data where observations are not independent, such as in longitudinal or group-based studies. The multivariate model was constructed in stages, starting with the bivariate analysis to identify factors that were statistically significant at the 0.2 level. A higher level was set in this initial phase to limit chances of excluding potentially significant factors early on. In this initial stage, variables that were found to be strongly associated with the outcomes of viral load suppression and retention in care were selected for inclusion in the multivariate model. The inclusion criteria for the multivariable model were based on the significance of the variables in the bivariate analysis, as well as their theoretical relevance based on previous research. Variables with non-significant associations were excluded from the multivariate model to reduce model complexity and prevent overfitting. The final multivariate model was thus designed to examine the independent associations of adherence, gender, DSDM approach, caregiver presence, school-going status , and the after-intervention variable on viral load suppression and retention in care. Level of significance was determined using p < 0.05 at 95% confidence interval (CI). Odds ratio was then preferred for reporting magnitude and direction of predictability of a variable to influence retention and viral load suppression. We used Standard for reporting Implementation Studies (StaRI) guidelines [ 31 ] for reporting the work. Results Overall (Table 2 a), from the original 533, at post intervention, there were 510 ALHIV considered for the analysis, including 53.1% females, mean age of 16.27 years, interquartile range of 12–19 years. Overall, retention rate improved from 95.9–97.3%. importantly, there was zero death during the intervention period compared to four in the twelve months prior. The good retention could be attributed to enhanced multi-month dispensing of ART with 64.2% of the clients, receiving drugs for at least six months. Further, viral load suppression rate improved from 84–92.7%. The improvement could be attributed to a web of factors such as improved disclosure of HIV status (99.8%), improved adherence rate (99%) and multi-month dispensing of drugs. Overall, 134 (26%) ALHIV directly benefitted from OTZ intervention. Table 2 a: Basic demographic characteristics of the ALHIV included in the study in the before and after study periods. BEFORE AFTER Variables Frequency (N = 533) Proportion (percentage) Frequency (N = 510) Proportion (percentage) Study centres TASO Mbale CoE 304 57.0 287 56.3 TASO Soroti CoE 229 43.0 223 43.7 Current age 12–14 Years 199 37.3 122 23.9 15–19 Years 334 62.7 388 76.1 Sex Female 289 54.2 271 53.1 Male 244 45.8 239 46.9 School going status Not at school 165 31.0 77 15.1 At school 368 69.0 433 84.9 Caregiver present No 8 1.5 2 0.4 Yes 525 98.5 508 99.6 Table 2 b: Clinical characteristics of the ALHIV included in the study in the before and after intervention periods. BEFORE AFTER Variables Frequency (N = 533) Proportion (percentage) Frequency (N = 510) Proportion (percentage) Current retention at 12 months Active 511 95.9 496 97.3 Died 4 0.8 0 0.0 Transferred Out 8 1.5 13 2.5 Lost > 28days 10 1.9 1 0.2 Current viral load suppression (12 Months most recent) Non-suppressed 87 16.3 35 7.1 Suppressed 446 83.7 459 92.7 No valid VL 0 0 1 0.2 Adherence scores Good 494 92.7 505 99.0 Fair 27 5.1 0 0.0 Poor 12 2.3 5 1.0 Current Differentiated service delivery model (DSDM) approach Community Client-led ART Delivery (CCLAD) 25 4.7 82 16.1 Community Drug Delivery Point (CDDP) 106 19.9 13 2.5 Facility-based groups (FBG) 354 66.4 370 72.5 Facility-based individual model (FBIM) 40 7.5 35 6.9 Fast-track drug refill (FTDR) 8 1.5 10 2.0 Tuberculosis (TB) status No signs and symptoms 498 93.4 501 98.2 Presumptive 28 5.3 4 0.8 TB diagnosed 7 1.3 5 1.0 Orphaned and vulnerable children (OVC) status Ever enrolled 323 60.6 389 76.3 Never enrolled 210 39.4 121 23.7 Benefited from OVC services No 62 19.2 8 2.1 Yes 261 80.8 381 97.9 Multi-month dispensing (MMD) < 3 months 51 10 3 0.6 3 to 5 months 261 51 174 35.2 6 + months 199 39 318 64.2 Disclosure status Disclosed 522 97.9 509 99.8 Not disclosed 11 2.1 01 0.2 Viral Load Suppression Participants at TASO Soroti CoE had significantly lower odds of achieving viral load suppression compared to those at TASO Mbale CoE (OR = 0.637, p = 0.027, 95%CI: 0.427–0.951) as indicated in Table 3 . Overall, participants at post-intervention were 2.4 times more likely to have suppressed viral loads (OR = 2.421, p < 0.001, 95%CI: 1.588–3.693), indicating the intervention's effectiveness. Adherence was strongly linked to viral load suppression. Participants with Fair adherence (OR = 0.014, p < 0.001, 95%CI: 0.004–0.049) and Poor adherence (OR = 0.027, p < 0.001, 95%CI: 0.007–0.102) had much lower odds of suppression compared to those with good adherence. After intervention (OR = 1.519, p = 0.076, 95%CI: 0.958–2.411) there was a moderate increase in odds of suppression, though not statistically significant at the 0.05 level. Table 3 Bivariate analysis Viral load suppression Retention Variables Crude OR P-value Confidence interval Crude OR P-value Confidence interval Study centres TASO Mbale CoE 1 TASO Soroti CoE 0.637 0.027* 0.427–0.951 1.448 0.311 0.707–2.964 After intervention 2.421 < 0.001* 1.588–3.693 1.453 0.292 0.725–2.915 Adherence scores Good 1 1 Fair 0.014 < 0.001* 0.004–0.049 1 - - Poor 0.027 < 0.001* 0.007–0.102 0.276 0.106 0.058–1.313 After intervention 1.519 0.076 0.958–2.411 1.483 0.275 0.732–3.003 Current age 12–14 Years 1 1 15–19 Years 0.628 0.052 0.393–1.004 1.764 0.112 0.876–3.551 After intervention 2.57 < 0.001* 1.673–3.950 1.34 0.415 0.663–2.710 Sex Female 1 1 Male 0.525 0.002* 0.350–0.788 0.613 0.167 0.306–1.227 After intervention 2.455 < 0.001* 1.607–3.748 1.45 0.295 0.724–2.907 School going status Not at school 1 1 At school 1.269 0.285 0.820–1.965 0.27 0.04 0.077–0.944 After intervention 2.318 < 0.001* 1.513–3.552 1.696382 0.154 .820 - 3.509 Caregiver present No 1 Yes 1 Omitted 3.37 0.256 0.415–27.390 After intervention 2.45 < 0.001* 1.606–3.737 1.422 0.32 0.710–2.848 Current Differentiated Service Delivery Model (DSDM) approach Facility-based individual management (FBIM) 1 1 Facility-based groups (FBG) 10.977 < 0.001* 6.248–19.284 3.426 0.011 1.319–8.897 Fast track drug refills (FTDR) 6.092 0.029* 1.200–30.917 0.771 0.762 0.143–4.165 Community client-led ART Delivery (CCLAD) 9.738 < 0.001* 3.699–25.640 7.359 0.066 0.879–61.602 Community drug delivery point (CDDP) 4.658 < 0.001* 2.314–9.377 1.408 0.574 0.427–4.636 After intervention 2.24 0.001* 1.417–3.540 1.18 0.67 0.552–2.524 Tuberculosis (TB) status No signs and symptoms 1 1 Presumptive 1.140709 0.835 0.330–3.94 1.003 0.998 0.132–7.634 TB diagnosed 1.300565 0.802 0.167–10.120 0.344 0.327 0.041–2.910 After intervention 2.526997 < 0.001* 1.667–3.831 1.447 0.302 0.717–2.922 Orphaned and vulnerable children (OVC) status Ever enrolled 1 1 Never enrolled 0.982 0.933 0.646–1.493 0.772 0.47 0.383–1.556 After intervention 2.418 < 0.001* 1.587–3.683 1.394 0.347 0.699–2.780 Benefited from OVC services No 1 1 Yes 0.982 0.933 0.646–1.493 0.391 0.369 0.050–3.030 After intervention 2.418 < 0.001* 1.587–3.683 1.291 0.57 0.535–3.115 Multi-month dispensing of drugs (MMD) < 3 months 3 to 5 months 4.159 < 0.001* 2.215–7.811 More than 5 months 9.537 < 0.001* 4.701–19.347 After intervention 1.598 0.046* 1.008–2.532 Disclosure status Not disclosed 1 1 Disclosed 1 Omitted 1.498 0.539 0.740–3.034 After intervention 2.349 < 0.001* 1.539–3.585 2.121 0.324 0.477–9.430 Males had lower odds of viral load suppression than females (OR = 0.525, p = 0.002, 95%CI: 0.350–0.788), suggesting gender-based disparities in suppression rates. Following the intervention, males showed a substantial improvement, with the odds of suppression increasing by 2.5 times (OR = 2.455, p < 0.001, 95%CI: 1.607–3.748). School-going status was not significantly associated with viral load suppression (OR = 1.269, p = 0.285, 95%CI: 0.820–1.965). However, after the intervention, participants who were at school had significantly higher odds of suppression (OR = 2.318, p < 0.001, 95%CI: 1.513–3.552). The presence of a caregiver was significantly associated with increased odds of suppression (OR = 2.45, p < 0.001, 95%CI: 1.606–3.737). This highlights the critical role of caregiver support in facilitating viral load suppression. The DSDM approach was strongly associated with suppression, particularly in models such as FBG (OR = 10.977, p < 0.001, 95%CI: 6.248–19.284), FTDR (OR = 6.092, p = 0.029, 95%CI: 1.200–30.917), and CCLAD (OR = 9.738, p < 0.001, 95%CI: 3.699–25.640). The after-intervention variable showed an overall positive effect on suppression (OR = 2.24, p = 0.001, 95%CI: 1.417–3.540). Enrolling in OVC services and benefiting from OVC services were strongly associated with increased viral load suppression after the intervention (OR = 2.418, p < 0.001, 95%CI: 1.587–3.683). MMD was significantly associated with viral load suppression, with participants on 3–5 months and more than 5 months MMD having higher odds of suppression (OR = 4.159, p < 0.001, 95%CI: 2.215–7.811 and OR = 9.537, p < 0.001, 95%CI: 4.701–19.347, respectively). After the intervention, participants on MMD still had significantly improved odds of suppression (OR = 1.598, p = 0.046, 95%CI: 1.008–2.532). The after-intervention variable had a significant impact on suppression for participants who had not disclosed their HIV status (OR = 2.349, p < 0.001, 95%CI: 1.539–3.585), suggesting the intervention's positive effect on those who had not disclosed their status. Retention Results show that adolescents who are not in school [a0R 0.27 95%CI (0.077–0.944) p = 0.04] were more likely to remain in care, as school attendance appears to reduce retention odds. This suggests that for adolescents not attending school, there may be fewer competing priorities or barriers to engagement in care. Another significant factor was the DSDM approach, particularly the facility-based Group approach (FBG), which greatly improves retention outcomes. Adolescents receiving care through FBG had more than three times the odds of remaining in care compared to those in the FBIM approach. This approach seems to be a strong model for encouraging retention. Multivariate Modeling Viral Load Suppression The multivariable analysis in Table 4 indicates that Adherence remained one of the most significant predictors of viral load suppression. Participants with poor adherence [ adjusted odds ratios [(aOR)0.03 95% CI ( 0.0038–0.23 ) p = 0.001] and fair adherence had [a OR = 0.02 95%CI ( 0.0037–0.11 ) p < 0.001)] were less likely to attain VLS. These findings underscore the critical role of adherence in ensuring effective HIV treatment. Regarding gender, males [aOR 0.5 95%CI (0.27–0.91) p = 0.024] were less likely than females to suppress their VL. Targeted interventions are required to support the males. For DSDM, participants in FBG [ aOR = 9.87, 95%CI ( 4.08–23.88 ) p < 0.001], CCLAD [ aOR 21.96 95%CI (2.68–179.84) and CDDPs [ aOR 95%CI (3.80–70.14) p < 0.001] were more likely to achieve VLS compared to other models. Table 4 multivariate analysis Viral load suppression Retention Variables Adjusted OR P-value Confidence interval Adjusted OR P-value Confidence interval Study centres TASO Mbale CoE 1 - - 1 - - TASO Soroti CoE 1.46 0.411 0.59–3.61 1.26 0.703 0.38–4.15 Adherence scores Good 1 - - 1 - - Fair 0.02 < 0.001 0.0037–0.11 - - - Poor 0.03 0.001* 0.0038–0.23 0.09 0.010* 0.02–0.57 Sex Female 1 - - 1 - - Male 0.5 0.024* 0.27–0.91 1.06 0.907 0.43–2.59 Current DSDM approach Facility-based individual management (FBIM) 1 - - 1 - - Facility-based groups (FBG) 9.87 < 0.001 4.08–23.88 7.36 0.001* 2.35–23.10 Fast-track drug refills (FTDR) 1 (omitted) (omitted) 0.78 0.834 0.08–7.70 Community client-led ART Delivery (CCLAD) 21.96 0.004* 2.68–179.84 1 (omitted) (omitted) Community drug delivery point (CDDP) 16.34 < 0.001* 3.80–70.14 3.25 0.182 0.58–18.30 Benefited from orphaned and vulnerable children (OVC) services No 1 - - 1 - - Yes 0.29 0.11 0.06–1.33 0.61 0.644 0.08–4.85 Multi-month drug dispensing (MMD) < 3 months 1 3 to 5 months 5.46 0.005* 1.66–17.93 More than 5 months 11.65 < 0.001* 2.93–46.34 Period Before intervention 1 After intervention 1.26 0.036* 0.61–2.61 1.033836 0.949 .375 2.853 *(p < 0.05) As for MMD, individuals who received drugs for 3–5 months [ aOR 5.46 (1.66–17.93) p = 0.005] and 6 + months [ aOR 11.65 ( 2.93–46.34) p < 0.001] during their last clinic visit had better odds of achieving VLS. MMD likely reduces chances of treatment interruption, encourages drug availability leading to good adherence. Lastly, the multivariate model found that participants in the post-intervention group [ aOR 1.26 ( 0.61–2.61) p = 0.036] had better chances of achieving viral suppression, compared to the pre-intervention period. However, given that CI appears to overlap 1, the intervention may not have strongly impacted the outcome in practical terms. Retention in Care Adolescents receiving care through FBG [aOR 7.36 95%CI (2.35–23.10) p = 0.001] had higher likelihood for remaining in care, compared to other models, likely due to improved adolescent friendly services. Regarding fidelity, table 5 provides the overall score. For the components measured, the total score was 80%, considered good fidelity. Table 5: Check list for fidelity scores Dimension Strategy Status (Y/N) Rating (/10) Adherence Kenyan team engaged N 0 Caregiver workshops conducted Y 1 Peers and health workers oriented/trained on OTZ Y 1 Monthly OTZ meetings conducted Y 2 Dosage Caregiver meeting held for at least 2 times Y 1 Monthly held for at least six times N 0 Quality of intervention delivery Continuous quality improvement projects implemented Y 1 Project Monitoring and evaluation done Y 1 Support supervision done Y 1 Total score 8 Discussion Our study adapted and evaluated the contribution of operation triple zero (OTZ) to improving both retention in care and HIV viral load suppression rate among the adolescents aged 10–19 years old. After one year post implementation, viral load suppression improved from 84–92.7% while retention also slightly improved from 96–97%. The improvement in VLS rhymes well with findings from Nigeria (92%) and Ethiopia (92%) [ 16 , 32 ]. Overall, these achievements were better than previous reports. For VLS, the 92.7% was better than the 69% and 80% respectively reported in Mbale, eastern Uganda, and 81% in Kabale, southwestern Uganda [ 5 , 8 , 9 ]. On the other hand, the retention rate was much higher than the 65.7%, 87% and 90% reported previously in Uganda [ 5 , 6 , 33 ]. VLS typically requires provision of optimal ART and adherence[ 34 ] both of which appear to have improved during the OTZ implementation, similar to what has been reported elsewhere [ 35 ]. Uganda implements a test and treat all policy with DTG-based regimens as the preferred anchor drug widely available across all HIV clinics in the country [ 14 ]. The improvement in VLS is attributable to the intervention which essentially led to improved adherence. Poor adherence had been identified earlier by health workers, caregivers and adolescents themselves as a key barrier to viral load suppression [ 15 ]. Fortunately, achieving optimal adherence is one of the principle objectives of the OTZ, through empowering of both caregivers and the ALHIV [ 19 ] in order to attain zero missed pills. The monthly and quarterly engagements of ALHIV and their caregivers respectively, were aimed at improving adherence through counselling, sharing experiences, designing personal improvement plans and addressing the question of social support systems. Also, there were additional deliberate efforts to improve adherence such as regular phone calls to offer virtual adherence support, greater involvement of the peers, supporting disclosure of HIV status to the adolescents, celebrating those who re-suppressed and home-based counselling in collaboration with the OVC team. These interventions were guided by the identified barriers and facilitators to VLS [ 15 ]. Improved adherence through enhanced counselling has been found to improve viral load suppression rates among PLHIV by up to 82% [ 36 ]. Therefore, OTZ likely enabled an interplay of various adolescent friendly health services provided, which greatly improved the positive outlook to life and treatment literacy among both caregivers and the adolescents. Relatedly, ALHIV who received their care through facility-based groups were more likely to suppress their viral load and remain in care. Differentiated service delivery is a person-centered approach that enables PLHIV to receive care from their preferred models [ 1 , 37 , 38 ]. It has been promoted as a key intervention for improving patient experience and onward treatment outcomes including viral load suppression [ 39 – 41 ]. Facility-based groups (FBG) include generally stable individuals who receive services as cohorts including children, adolescents, pregnant and breastfeeding women[ 14 ]. During the intervention period, ALHIV in the FBG received continued adherence support through peer-driven counselling, experience sharing with individuals who had suppressed their viral loads declaring their initiatives to attain sustained VLS status and also, caregiver literacy through health education. Indeed, social support groups have been reported to contribute to improved treatment outcomes [ 42 , 43 ]. Further, ALHIV who received multi-month dispensing (MMD) of drugs had significantly better odds of attaining VLS during the intervention, similar to findings by Ainembabazi et al. [ 5 ]. Receiving drugs for at least three months enables PLHIV to adhere well for long because of sustained availability of the pills. However, ongoing counselling is important to strengthen adherence while clients are away from the clinics for long in order to sustain viral load suppression [ 5 ]. In this study, only 0.6% had received drug refills for less than three months during their last clinic visit. With the odds of up to 11.5 to achieve viral load suppression, this finding should therefore encourage health workers who are currently hesitant to implement MMD among ALHIV, to confidently do so. As reported elsewhere, MMD reduces work/study interruptions, saves people’s time, reduces workload on the health workers, improves adherence and a good antidote to stigma and discrimination [ 44 ]. Whereas association of gender and viral load suppression has been found to be mixed, our study found males were less likely to attain a suppressed VL compared to the females, consistent with findings from Uganda, South Africa, Zimbabwe and Kenya [ 9 , 34 , 45 , 46 ]. This could be due to negative peer influence, reluctance of males to seek and/or utilize healthcare services [ 9 , 34 ], gross internal stigma, inadequate social support and absence of male-friendly services in the facilities [ 45 ]. There is need to identify and address male specific issues in order to improve treatment outcomes by providing targeted interventions. Finally, we acknowledge important study strengths such as: using routine program data likely reflects realities on the ground, use of RE-AIM offered a standardized way of conducting the evaluation, and a good study design that enabled us to compare the pre-and post-intervention periods. Conversely, study limitations included: implementation in COEs only, limiting potential applicability in public health sites. Whereas the setting maybe different, the same ministry of health package is implemented across all facilities in Uganda. Thus, the findings may yet be applicable across board despite the few variations. Also, only few ALHIV directly benefited from the model, limiting its potential wider effect on treatment outcomes. Despite this, all the adolescents benefitted from the intervention secondarily through improved skills from the health workers which led to enhanced implementation of adolescent friendly services including HIV status disclosure, differentiated service delivery and multi-month dispensing of drugs. Suffice to mention that while there were no policy changes during the implementation period, other contributing enhancers such as quality improvement and OVC models strengthened the intervention. Important to note that the intervention improved the implementation of the OVC in the settings. Conclusions Overall, OTZ improved retention and VLS in the setting due to implementation of adolescent friendly health services such as MMD, various DSDMs which improved the adherence considerably. We envisage that OTZ has the potential to improve person-centered care for the adolescents by individualizing care, empowering the service providers and caregivers as well. Recommendations We recommend a wider implementation of the model in Uganda to close the current VLS gaps among the adolescents living with HIV. Through this model, adolescent health friendly services such as multi-month dispensing, and community-based differentiated models can be scaled up to address poor treatment outcomes. Abbreviations ALHIV Adolescent living with HIV ART Antiretroviral therapy AYPLHIV Adolescents and young people living with HIV CATS Community adolescent treatment supporter CCLAD Community client-led ART Delivery CDDP Community Drug Delivery Points COE Center of Excellence DSDM Differentiated Service Delivery Model DTG Dolutegravir FBG Facility-based group FBIM Facility-based Individual Management FTR Fast-track refill GEE Generalized Estimating Equations MMD multi-month dispensing OR Odds Ratio OTZ Operation Triple Zero OVC Orphaned and Vulnerable Children PLHIV People living with HIV RE AIM-Reach, Effectiveness, Adoption, Implementation and Maintenance RNA Ribonucleic acid TASO The AIDS Support Organization VLS Viral load suppression WHO World health organization YAPS Youth and adolescent treatment supporter Declarations Ethical Consideration The study received ethical approval from TASO institutional review board (TASO‑ REC‑2022–176) and the Uganda National Council of Science and Technology (UNCST), registration number SS1610ES . Authors’ contributions BO: Scientific direction, protocol development, resource mobilization, methodology design, interpretation of results, manuscript drafting, and overall coordination. AK, CA, BB, TMN, DK and SMS contributed to developing the protocol, methodology design and writing the draft manuscript. ENM contributed to protocol development, reviewed the manuscript and mobilized resources. EBM, KM and YM reviewed the final draft and contributed significant input to the work. AIO: methodology design and data analysis. All authors read and approved the final manuscript. Funding This study was funded by the International Pediatric HIV Symposium in Africa (IPHASA) of the International AIDS Society (IAS), grant number 0184. Acknowledgements We appreciate the study participants, IPHASA team for technical and logistical support, staff of TASO Mbale and Soroti COEs as well as management of TASO Uganda for their invaluable contributions. 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AIDS Res Ther. 2021;18:1–9. https://doi.org/10.1186/s12981-021-00391-7 . KING’ORI BM. FACTORS ASSOCIATED WITH VIRAL NON-SUPPRESSION AMONG HIV POSITIVE ADOLESCENTS IN CHULAIMBO HOSPITAL, KISUMU COUNTY,KENYA. Moi Univ. 5–24 (2020). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 20 May, 2025 Read the published version in AIDS Research and Therapy → Version 1 posted Editorial decision: Accepted 09 May, 2025 Reviews received at journal 08 May, 2025 Reviews received at journal 08 May, 2025 Reviewers agreed at journal 20 Apr, 2025 Reviewers agreed at journal 17 Apr, 2025 Reviewers invited by journal 16 Apr, 2025 Submission checks completed at journal 07 Apr, 2025 First submitted to journal 06 Apr, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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(PLHIV). HIV RNA Viral load (VL) is classified as suppressed if below 1000 RNA copies/ml and non-suppressed if above that in most programs. Achieving sustained suppressed viral load is the ultimate goal of ART and a precursor to reaching the epidemic control by 2030. In 2023, 93% of all people living with HIV (PLHIV) and on ART had suppressed their viral load across the globe, still below the 95% target by 2025. Despite this progress among the general population, only 48% of children and adolescents aged below 15 years had attained VL suppression [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Indeed, adolescents living with HIV aged 10\u0026ndash;19 years continue to lag and a recent systematic review reported a VL suppression rate of 55% in sub-Saharan Africa, including Uganda [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn Uganda, recent findings indicate viral load suppression and retention among children and adolescents living with HIV (CALHIV) of 80% and 87% respectively [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Another study reported a 12-month retention among the youth aged 15\u0026ndash;24 years old of 65.7% and Izudi reported 90% following a quality improvement intervention in one facility [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Further, Maena et al. reported viral load suppression among the adolescents of 69%, and a more recent study found an 81% rate in Uganda\u0026rsquo;s Kabale district [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. All these indicate sub-optimal retention and viral load suppression rates of less than the expected 95%. To attain sustained VL suppression, adolescents living with HIV (ALHIV), aged 10\u0026ndash;19 years, need to remain in care and adhere well. This requires programs to implement adolescent health friendly services such as peer driven approaches that include the community adolescent treatment support (CATS) of Zimbabwe, the Youth and Adolescent Peer Supporters (YAPS) in Uganda and the operation triple zero in Kenya [\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Uganda has implemented the YAPS model to improve retention and viral load suppression among the adolescents and young people living with HIV (AYPLHIV) since 2019. The YAPS are aged 18\u0026ndash;24 years, overcame internal stigma, able to read and write in English [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. In addition, other modalities such as differentiated service deliver models including community drug delivery points, treatment optimization with Dolutegravir (DTG) and multi-month dispensing have also been implemented to improve treatment outcomes [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Unfortunately, both retention and VL suppression remain sub-optimal in Uganda. In The AIDS Support Organization (TASO) Soroti and Mbale centers of excellence, viral load suppression was at 84%, far below the expected 95% target, and one year retention rate of 96% among the ALHIV [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis sub-optimal VL suppression rate necessitated a re-imagination of the current approach to adolescent peer support services. As per the success of the operation triple zero (OTZ) [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] elsewhere, it was considered for implementation in TASO Soroti and Mbale COEs. As detailed in the protocol, OTZ aims to achieve zero missed appointment, zero missed pill and zero viral load among the adolescents and young people living with HIV [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. This asset-based model aims at improving the health of AYPLHIV by making them active participants of creating optimal health strategies through a multidisciplinary undertaking. The model entails empowering the adolescents and young people living with HIV, health workers and caregivers using their respective packages as provided for in the national guidelines. The package for caregivers offers basic knowledge about HIV and how to groom an adolescent and young person while that for health workers includes training on the comprehensive ministry of health package for the same population. Finally, the AYPLHIV are provided with basic information about HIV, living positively with HIV and other coping mechanisms [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. The typical implementation involves quarterly caregiver meetings and monthly meetings of the AYPLHIV led by the OTZ champions which can take place both in the facility and community [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study thus evaluated the one-year contribution of OTZ to improving VL suppression and retention among the sub-population in the TASO setting. The Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework of implementation science was used to guide the evaluation [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. The findings provide further insights toward scaling up of the model in similar settings.\u003c/p\u003e"},{"header":"Methodology","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design\u003c/h2\u003e \u003cp\u003eThis was a before and after study design. We compared both retention and viral load suppression among the ALHIV before the implementation of OTZ and twelve months after the intervention. A formative approach was employed in this implementation science, from July 2023 to June 2024. Supported by the consolidated framework for implementation research (CFIR) [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], we conducted a mixed methods study to identify barriers and facilitators to retention and viral load suppression among the adolescents living with HIV (ALHIV) in the setting. These enabled the research team to adapt the operation triple zero (OTZ) to fit the context, using ADAPTIT framework [\u003cspan additionalcitationids=\"CR23\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. The adaptation plan was collectively developed with the facility teams, and documented using framework for reporting adaptations and modifications (FRAME) [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Facility teams were oriented on the implementation of OTZ and standard operating procedures developed to guide health workers.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy Setting\u003c/h3\u003e\n\u003cp\u003eThe study was conducted in The AIDS Support Organization (TASO) centers of excellence, Mbale and Soroti, home to more than 13,000 PLHIV as detailed in the protocol [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The two COEs provide comprehensive HIV services including prevention, care and treatment interventions to children, adolescents and adults. Both COEs are east of Kampala, capital city, approximately, 224 and 324 kilometers away, respectively. Each COE serves people living with HIV who come from at least 23 districts, a radius of 75 kilometers.\u003c/p\u003e\n\u003ch3\u003eStudy Population\u003c/h3\u003e\n\u003cp\u003eAdolescents living with HIV aged 10\u0026ndash;17 years of age who were active in care in the April-June 2022 quarter. These were followed up longitudinally to establish their status for retention and viral load suppression at 12 months before and after the intervention.\u003c/p\u003e\n\u003ch3\u003eSample Size Estimation and Sampling Techniques\u003c/h3\u003e\n\u003cp\u003eWe used a census to enroll all the ALHIV who were active in care during the April-June 2022 quarter for the analysis.\u003c/p\u003e\n\u003ch3\u003eThe Intervention Description\u003c/h3\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eGeneral overview\u003c/h2\u003e \u003cp\u003eA multi-disciplinary team composing of a clinician, counsellor and peer (leveraged the YAPS) was oriented on the adapted OTZ model for one day. The orientation included a refresher on Uganda 2022 national consolidated guidelines service package for ALHIV [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], communicating with adolescents, and how to nurture adolescents. The adapted components of OTZ included monthly engagement of adolescents with non-suppressed viral load, quarterly literacy sessions with caregivers of the ALHIV with high viral load, and other clinical services as required. These sessions were differentiated to both facility and community. During the engagements, the teams offered respective packages to the two groups, empowering them to take more responsibilities in improving the health outcomes of the ALHIV. To support the health workers, standard operating procedures were developed and users were mentored to use them appropriately.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eEngagement with ALHIV\u003c/h3\u003e\n\u003cp\u003e During the monthly engagements, each adolescent was empowered to come up with a written personal health improvement plan, and this was filed for future reference. The monthly meetings were championed by the peers who led various activities including treatment literacy sessions, sharing experiences among the adolescents to build each other\u0026rsquo;s self-esteem and empowering the clients to have a positive outlook into life. The peers also conducted pre-appointment reminders, follow-up of those who missed their appointment and community-based adherence support. Further, adolescents were also provided with financial literacy sessions, and in collaboration with Mbale Network of Young People Living with HIV/AIDS (MNYPA), trained 21 out of school adolescents with basic skills such as liquid soap making. To strengthen the implementation further, bi-weekly check-in by the research team and monthly by the technical team from International Pediatric HIV/AIDS Symposium in Africa (IPHASA) to offer additional guidance were conducted. Lastly, continuous quality improvement was also integrated into the intervention as well to ensure adequacy of the implementation.\u003c/p\u003e\n\u003ch3\u003eThe caregiver engagement\u003c/h3\u003e\n\u003cp\u003eThere were two caregiver meetings. The caregivers of ALHIV with unsuppressed viral load were gathered in one place (both facility and community) and provided with basic information about HIV including its transmission and management; adherence to ART, disclosing HIV status to an adolescent, stigma and discrimination, sexual and reproductive health issues and how to empower an adolescent to lead an independent life.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eData Management\u003c/h2\u003e \u003cdiv id=\"Sec12\" class=\"Section3\"\u003e \u003ch2\u003eData Collection\u003c/h2\u003e \u003cdiv id=\"Sec13\" class=\"Section4\"\u003e \u003ch2\u003eEvaluation Framework\u003c/h2\u003e \u003cp\u003eWe used Reach, Effectiveness, Adoption, Implementation Maintenance (RE-AIM) framework to determine the variables to collect. RE-AIM is a popular implementation science framework that helps standardize program evaluation data collection and it states that interventions are impactful if effective evidence-based intervention reaches a wide proportion of the public, through adoption by willing entities, implemented as intended and maintained over time [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan additionalcitationids=\"CR27\" citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. The model has been used elsewhere to evaluate programs such as integration of methadone into ART in Tanzania, economic empowerment interventions as HIV prevention programs among adolescent girls and young women in sub-Saharan Africa, and the continuum of care management in Brazil [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. In this study, we used Reach, Effectiveness and Implementation dimensions to guide the evaluation of OTZ program. The three dimensions were best suited to guide data collection required to answer the research questions and the others (adoption and maintenance) were irrelevant to the current study, hence not considered. Table\u0026nbsp;1 summarizes the dimensions of RE-AIM used to guide measurement of the primary outcomes.\u003c/p\u003e \n\u003cp\u003eTable 1: Dimensions of RE-AIM used to measure primary outcomes.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"645\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDimension\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 535px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDescription\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003eReach\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 535px;\"\u003e\n \u003cp\u003eProportion of adolescents living with HIV who were enrolled into the model\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003eEffectiveness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 535px;\"\u003e\n \u003cp\u003eProportion of individuals with HIV viral RNA copies of less than 1000/ml.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 535px;\"\u003e\n \u003cp\u003eRetention: Proportion of adolescents who were active in care by the end of June 2024. This was categorized into active (if ALHIV had their most recent clinic encounter is at least 28 days within the next scheduled appointment), transferred out for those who moved to other facilities, dead for those who died and lost for those who had no clinic contact for at least 28 days their last scheduled appointment. \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003eImplementation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 535px;\"\u003e\n \u003cp\u003eFidelity (extent of the implementation of the adapted model). Fidelity is the extent to which an intervention is implemented as planned [25]. We used self report and observation to collect data on fidelity, basing on the adaptation plan developed at the start of the implementation of OTZ.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWe used the same questionnaire as at baseline to collect post-implementation data as well. A virtual re-orientation of the data collection team was done prior. Data collection was done using Kobo collect, version 2.024.19. The variables included: Age, viral load status, ART status, HIV status disclosure status, school going status, differentiated service delivery model, presence of caregiver and Tuberculosis (TB) status.\u003c/p\u003e \u003cp\u003eFor fidelity, self-report was used to collect data on some of the key implementation components basing on the adaptation plan. Three dimensions of adherence, dosage and quality of the implementation were considered. Each core component of OTZ was assigned one point except monthly OTZ meetings which received two marks. Arbitrarily, a score of below 50% was considered poor; 50\u0026ndash;79%, fair and 80%+, good fidelity. Given that the two sites are generally similar and thus variation in implementation was negligible, overall fidelity was considered.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eUnivariate analysis was reported as frequencies and proportions. The \u003cb\u003eGeneralized Estimating Equations (GEE)\u003c/b\u003e approach was used to build the multivariate model, a method suitable for analysing clustered data where observations are not independent, such as in longitudinal or group-based studies. The multivariate model was constructed in stages, starting with the \u003cb\u003ebivariate analysis\u003c/b\u003e to identify factors that were statistically significant at the 0.2 level. A higher level was set in this initial phase to limit chances of excluding potentially significant factors early on. In this initial stage, variables that were found to be strongly associated with the outcomes of viral load suppression and retention in care were selected for inclusion in the multivariate model.\u003c/p\u003e \u003cp\u003eThe inclusion criteria for the multivariable model were based on the significance of the variables in the bivariate analysis, as well as their theoretical relevance based on previous research. Variables with non-significant associations were excluded from the multivariate model to reduce model complexity and prevent overfitting. The final multivariate model was thus designed to examine the independent associations of \u003cb\u003eadherence, gender, DSDM approach, caregiver presence, school-going status\u003c/b\u003e, and the \u003cb\u003eafter-intervention variable\u003c/b\u003e on viral load suppression and retention in care. Level of significance was determined using p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 at 95% confidence interval (CI). Odds ratio was then preferred for reporting magnitude and direction of predictability of a variable to influence retention and viral load suppression. We used Standard for reporting Implementation Studies (StaRI) guidelines [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e] for reporting the work.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eOverall (Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003ea), from the original 533, at post intervention, there were 510 ALHIV considered for the analysis, including 53.1% females, mean age of 16.27 years, interquartile range of 12\u0026ndash;19 years. Overall, retention rate improved from 95.9\u0026ndash;97.3%. importantly, there was zero death during the intervention period compared to four in the twelve months prior. The good retention could be attributed to enhanced multi-month dispensing of ART with 64.2% of the clients, receiving drugs for at least six months. Further, viral load suppression rate improved from 84\u0026ndash;92.7%. The improvement could be attributed to a web of factors such as improved disclosure of HIV status (99.8%), improved adherence rate (99%) and multi-month dispensing of drugs. Overall, 134 (26%) ALHIV directly benefitted from OTZ intervention.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ea: Basic demographic characteristics of the ALHIV included in the study in the before and after study periods.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eBEFORE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eAFTER\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency (N\u0026thinsp;=\u0026thinsp;533)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eProportion (percentage)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFrequency (N\u0026thinsp;=\u0026thinsp;510)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eProportion (percentage)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudy centres\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTASO Mbale CoE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e304\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e57.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e287\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e56.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTASO Soroti CoE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e229\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e43.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e223\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e43.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCurrent age\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12\u0026ndash;14 Years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e199\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e37.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e122\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e23.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15\u0026ndash;19 Years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e334\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e62.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e388\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e76.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e289\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e54.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e271\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e53.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e244\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e45.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e239\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e46.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSchool going status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot at school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e165\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e15.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAt school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e368\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e69.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e433\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e84.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCaregiver present\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e525\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e98.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e508\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e99.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eb: Clinical characteristics of the ALHIV included in the study in the before and after intervention periods.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eBEFORE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eAFTER\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency (N\u0026thinsp;=\u0026thinsp;533)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eProportion (percentage)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFrequency (N\u0026thinsp;=\u0026thinsp;510)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eProportion (percentage)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCurrent retention at 12 months\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eActive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e511\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e496\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e97.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDied\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTransferred Out\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLost\u0026thinsp;\u0026gt;\u0026thinsp;28days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCurrent viral load suppression (12 Months most recent)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-suppressed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSuppressed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e446\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e83.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e459\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e92.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo valid VL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAdherence scores\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e494\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e92.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e505\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e99.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFair\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCurrent Differentiated service delivery model (DSDM) approach\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCommunity Client-led ART Delivery (CCLAD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCommunity Drug Delivery Point (CDDP)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e106\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFacility-based groups (FBG)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e354\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e370\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e72.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFacility-based individual model (FBIM)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFast-track drug refill (FTDR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTuberculosis (TB) status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo signs and symptoms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e498\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e93.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e501\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e98.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePresumptive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTB diagnosed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOrphaned and vulnerable children (OVC) status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEver enrolled\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e323\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e389\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e76.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever enrolled\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e210\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e121\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e23.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBenefited from OVC services\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e261\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e80.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e381\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e97.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMulti-month dispensing (MMD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;3 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3 to 5 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e261\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e174\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e35.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u0026thinsp;+\u0026thinsp;months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e199\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e318\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e64.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDisclosure status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDisclosed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e522\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e97.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e509\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e99.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot disclosed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eViral Load Suppression\u003c/h2\u003e \u003cp\u003eParticipants at \u003cb\u003eTASO Soroti CoE\u003c/b\u003e had significantly lower odds of achieving viral load suppression compared to those at \u003cb\u003eTASO Mbale CoE\u003c/b\u003e (OR\u0026thinsp;=\u0026thinsp;0.637, p\u0026thinsp;=\u0026thinsp;0.027, 95%CI: 0.427\u0026ndash;0.951) as indicated in Table \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. Overall, participants at post-intervention were 2.4 times more likely to have suppressed viral loads (OR\u0026thinsp;=\u0026thinsp;2.421, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, 95%CI: 1.588\u0026ndash;3.693), indicating the intervention's effectiveness. Adherence was strongly linked to viral load suppression. Participants with \u003cb\u003eFair\u003c/b\u003e adherence (OR\u0026thinsp;=\u0026thinsp;0.014, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, 95%CI: 0.004\u0026ndash;0.049) and \u003cb\u003ePoor\u003c/b\u003e adherence (OR\u0026thinsp;=\u0026thinsp;0.027, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, 95%CI: 0.007\u0026ndash;0.102) had much lower odds of suppression compared to those with \u003cb\u003egood\u003c/b\u003e adherence. \u003cb\u003eAfter intervention\u003c/b\u003e (OR\u0026thinsp;=\u0026thinsp;1.519, p\u0026thinsp;=\u0026thinsp;0.076, 95%CI: 0.958\u0026ndash;2.411) there was a moderate increase in odds of suppression, though not statistically significant at the 0.05 level.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBivariate analysis\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eViral load suppression\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eRetention\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCrude OR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eConfidence interval\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCrude OR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eConfidence interval\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudy centres\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTASO Mbale CoE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTASO Soroti CoE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.637\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.027*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.427\u0026ndash;0.951\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.448\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.311\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.707\u0026ndash;2.964\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAfter intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.421\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.588\u0026ndash;3.693\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.453\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.292\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.725\u0026ndash;2.915\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAdherence scores\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFair\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.004\u0026ndash;0.049\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.027\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.007\u0026ndash;0.102\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.276\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.106\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.058\u0026ndash;1.313\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eAfter intervention\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.519\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.076\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.958\u0026ndash;2.411\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.483\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.275\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.732\u0026ndash;3.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCurrent age\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12\u0026ndash;14 Years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15\u0026ndash;19 Years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.628\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.052\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.393\u0026ndash;1.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.764\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.112\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.876\u0026ndash;3.551\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eAfter intervention\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.673\u0026ndash;3.950\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.415\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.663\u0026ndash;2.710\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.525\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.002*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.350\u0026ndash;0.788\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.613\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.167\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.306\u0026ndash;1.227\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eAfter intervention\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.455\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.607\u0026ndash;3.748\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.295\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.724\u0026ndash;2.907\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSchool going status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot at school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAt school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.269\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.285\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.820\u0026ndash;1.965\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.04\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.077\u0026ndash;0.944\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eAfter intervention\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.318\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.513\u0026ndash;3.552\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.696382\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.154\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.820 - 3.509\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCaregiver present\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOmitted\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.256\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.415\u0026ndash;27.390\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eAfter intervention\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.606\u0026ndash;3.737\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.422\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.710\u0026ndash;2.848\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCurrent Differentiated Service Delivery Model (DSDM) approach\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFacility-based individual management (FBIM)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFacility-based groups (FBG)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.977\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.248\u0026ndash;19.284\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.426\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.011\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.319\u0026ndash;8.897\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFast track drug refills (FTDR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.092\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.029*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.200\u0026ndash;30.917\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.771\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.762\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.143\u0026ndash;4.165\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCommunity client-led ART Delivery (CCLAD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.738\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.699\u0026ndash;25.640\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.359\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.066\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.879\u0026ndash;61.602\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCommunity drug delivery point (CDDP)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.658\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.314\u0026ndash;9.377\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.408\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.574\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.427\u0026ndash;4.636\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eAfter intervention\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.417\u0026ndash;3.540\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.552\u0026ndash;2.524\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTuberculosis (TB) status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo signs and symptoms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePresumptive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.140709\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.835\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.330\u0026ndash;3.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.998\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.132\u0026ndash;7.634\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTB diagnosed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.300565\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.802\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.167\u0026ndash;10.120\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.344\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.327\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.041\u0026ndash;2.910\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eAfter intervention\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.526997\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.667\u0026ndash;3.831\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.447\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.302\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.717\u0026ndash;2.922\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOrphaned and vulnerable children (OVC) status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEver enrolled\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever enrolled\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.982\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.933\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.646\u0026ndash;1.493\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.772\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.383\u0026ndash;1.556\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eAfter intervention\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.418\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.587\u0026ndash;3.683\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.394\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.347\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.699\u0026ndash;2.780\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBenefited from OVC services\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.982\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.933\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.646\u0026ndash;1.493\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.391\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.369\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.050\u0026ndash;3.030\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eAfter intervention\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.418\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.587\u0026ndash;3.683\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.291\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.535\u0026ndash;3.115\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMulti-month dispensing of drugs (MMD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;3 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3 to 5 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.159\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.215\u0026ndash;7.811\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMore than 5 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.537\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.701\u0026ndash;19.347\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eAfter intervention\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.598\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.046*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.008\u0026ndash;2.532\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDisclosure status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot disclosed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDisclosed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOmitted\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.498\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.539\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.740\u0026ndash;3.034\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eAfter intervention\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.349\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.539\u0026ndash;3.585\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.121\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.324\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.477\u0026ndash;9.430\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eMales had lower odds of viral load suppression than females (OR\u0026thinsp;=\u0026thinsp;0.525, p\u0026thinsp;=\u0026thinsp;0.002, 95%CI: 0.350\u0026ndash;0.788), suggesting gender-based disparities in suppression rates. Following the intervention, males showed a substantial improvement, with the odds of suppression increasing by 2.5 times (OR\u0026thinsp;=\u0026thinsp;2.455, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, 95%CI: 1.607\u0026ndash;3.748). \u003cb\u003eSchool-going\u003c/b\u003e status was not significantly associated with viral load suppression (OR\u0026thinsp;=\u0026thinsp;1.269, p\u0026thinsp;=\u0026thinsp;0.285, 95%CI: 0.820\u0026ndash;1.965). However, after the intervention, participants who were at school had significantly higher odds of suppression (OR\u0026thinsp;=\u0026thinsp;2.318, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, 95%CI: 1.513\u0026ndash;3.552).\u003c/p\u003e \u003cp\u003eThe presence of a caregiver was significantly associated with increased odds of suppression (OR\u0026thinsp;=\u0026thinsp;2.45, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, 95%CI: 1.606\u0026ndash;3.737). This highlights the critical role of caregiver support in facilitating viral load suppression. The \u003cb\u003eDSDM approach\u003c/b\u003e was strongly associated with suppression, particularly in models such as \u003cb\u003eFBG\u003c/b\u003e (OR\u0026thinsp;=\u0026thinsp;10.977, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, 95%CI: 6.248\u0026ndash;19.284), \u003cb\u003eFTDR\u003c/b\u003e (OR\u0026thinsp;=\u0026thinsp;6.092, p\u0026thinsp;=\u0026thinsp;0.029, 95%CI: 1.200\u0026ndash;30.917), and \u003cb\u003eCCLAD\u003c/b\u003e (OR\u0026thinsp;=\u0026thinsp;9.738, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, 95%CI: 3.699\u0026ndash;25.640). The \u003cb\u003eafter-intervention\u003c/b\u003e variable showed an overall positive effect on suppression (OR\u0026thinsp;=\u0026thinsp;2.24, p\u0026thinsp;=\u0026thinsp;0.001, 95%CI: 1.417\u0026ndash;3.540). Enrolling in \u003cb\u003eOVC services\u003c/b\u003e and benefiting from \u003cb\u003eOVC services\u003c/b\u003e were strongly associated with increased viral load suppression after the intervention (OR\u0026thinsp;=\u0026thinsp;2.418, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, 95%CI: 1.587\u0026ndash;3.683). \u003cb\u003eMMD\u003c/b\u003e was significantly associated with viral load suppression, with participants on \u003cb\u003e3\u0026ndash;5 months\u003c/b\u003e and \u003cb\u003emore than 5 months\u003c/b\u003e MMD having higher odds of suppression (OR\u0026thinsp;=\u0026thinsp;4.159, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, 95%CI: 2.215\u0026ndash;7.811 and OR\u0026thinsp;=\u0026thinsp;9.537, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, 95%CI: 4.701\u0026ndash;19.347, respectively). After the intervention, participants on MMD still had significantly improved odds of suppression (OR\u0026thinsp;=\u0026thinsp;1.598, p\u0026thinsp;=\u0026thinsp;0.046, 95%CI: 1.008\u0026ndash;2.532).\u003c/p\u003e \u003cp\u003eThe \u003cb\u003eafter-intervention\u003c/b\u003e variable had a significant impact on suppression for participants who had \u003cb\u003enot disclosed\u003c/b\u003e their HIV status (OR\u0026thinsp;=\u0026thinsp;2.349, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, 95%CI: 1.539\u0026ndash;3.585), suggesting the intervention's positive effect on those who had not disclosed their status.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eRetention\u003c/h2\u003e \u003cp\u003eResults show that adolescents who are not in school [a0R 0.27 95%CI (0.077\u0026ndash;0.944) p\u0026thinsp;=\u0026thinsp;0.04] were more likely to remain in care, as school attendance appears to reduce retention odds. This suggests that for adolescents not attending school, there may be fewer competing priorities or barriers to engagement in care. Another significant factor was the DSDM approach, particularly the facility-based Group approach (FBG), which greatly improves retention outcomes. Adolescents receiving care through FBG had more than three times the odds of remaining in care compared to those in the FBIM approach. This approach seems to be a strong model for encouraging retention.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eMultivariate Modeling\u003c/h2\u003e \u003cdiv id=\"Sec19\" class=\"Section3\"\u003e \u003ch2\u003eViral Load Suppression\u003c/h2\u003e \u003cp\u003eThe multivariable analysis in Table \u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e indicates that \u003cb\u003eAdherence\u003c/b\u003e remained one of the most significant predictors of viral load suppression. Participants with \u003cb\u003epoor adherence\u003c/b\u003e [\u003cb\u003eadjusted odds ratios [(aOR)0.03 95% CI (\u003c/b\u003e0.0038\u0026ndash;0.23\u003cb\u003e)\u003c/b\u003e p\u0026thinsp;=\u0026thinsp;0.001] and \u003cb\u003efair adherence\u003c/b\u003e had [a\u003cb\u003eOR\u0026thinsp;=\u0026thinsp;0.02 95%CI (\u003c/b\u003e0.0037\u0026ndash;0.11\u003cb\u003e)\u003c/b\u003e p\u0026thinsp;\u0026lt;\u0026thinsp;0.001)] were less likely to attain VLS. These findings underscore the critical role of adherence in ensuring effective HIV treatment. Regarding gender, males [aOR 0.5 95%CI (0.27\u0026ndash;0.91) p\u0026thinsp;=\u0026thinsp;0.024] were less likely than females to suppress their VL. Targeted interventions are required to support the males. For DSDM, participants in FBG [\u003cb\u003eaOR\u0026thinsp;=\u0026thinsp;9.87, 95%CI (\u003c/b\u003e4.08\u0026ndash;23.88\u003cb\u003e)\u003c/b\u003e p\u0026thinsp;\u0026lt;\u0026thinsp;0.001], CCLAD [\u003cb\u003eaOR\u003c/b\u003e 21.96 95%CI (2.68\u0026ndash;179.84) and CDDPs [\u003cb\u003eaOR\u003c/b\u003e 95%CI (3.80\u0026ndash;70.14) p\u0026thinsp;\u0026lt;\u0026thinsp;0.001] were more likely to achieve VLS compared to other models.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003emultivariate analysis\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eViral load suppression\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eRetention\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAdjusted OR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eConfidence interval\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAdjusted OR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eConfidence interval\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudy centres\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTASO Mbale CoE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTASO Soroti CoE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.411\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.59\u0026ndash;3.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.703\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.38\u0026ndash;4.15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAdherence scores\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFair\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0037\u0026ndash;0.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0038\u0026ndash;0.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.010*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.02\u0026ndash;0.57\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.024*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.27\u0026ndash;0.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.907\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.43\u0026ndash;2.59\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCurrent DSDM approach\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFacility-based individual management (FBIM)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFacility-based groups (FBG)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.08\u0026ndash;23.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.35\u0026ndash;23.10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFast-track drug refills (FTDR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e(omitted)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(omitted)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.834\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.08\u0026ndash;7.70\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCommunity client-led ART Delivery (CCLAD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.004*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.68\u0026ndash;179.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(omitted)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(omitted)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCommunity drug delivery point (CDDP)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.80\u0026ndash;70.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.182\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.58\u0026ndash;18.30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBenefited from orphaned and vulnerable children (OVC) services\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.06\u0026ndash;1.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.644\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.08\u0026ndash;4.85\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMulti-month drug dispensing (MMD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;3 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3 to 5 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.005*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.66\u0026ndash;17.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMore than 5 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.93\u0026ndash;46.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePeriod\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBefore intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAfter intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.036*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.61\u0026ndash;2.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.033836\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.949\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.375 2.853\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e*(p\u0026thinsp;\u0026lt;\u0026thinsp;0.05)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eAs for MMD, individuals\u003c/b\u003e who received drugs for 3\u0026ndash;5 months [\u003cb\u003eaOR\u003c/b\u003e 5.46 (1.66\u0026ndash;17.93) p\u0026thinsp;=\u0026thinsp;0.005] and 6\u0026thinsp;+\u0026thinsp;months [\u003cb\u003eaOR 11.65 (\u003c/b\u003e2.93\u0026ndash;46.34) p\u0026thinsp;\u0026lt;\u0026thinsp;0.001] during their last clinic visit had better odds of achieving VLS. MMD likely reduces chances of treatment interruption, encourages drug availability leading to good adherence. Lastly, the multivariate model found that participants in the \u003cb\u003epost-intervention group\u003c/b\u003e [\u003cb\u003eaOR 1.26 (\u003c/b\u003e0.61\u0026ndash;2.61) p\u0026thinsp;=\u0026thinsp;0.036] had better chances of achieving viral suppression, compared to the pre-intervention period. However, given that CI appears to overlap 1, the intervention may not have strongly impacted the outcome in practical terms.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eRetention in Care\u003c/h2\u003e \u003cp\u003eAdolescents receiving care through \u003cb\u003eFBG [aOR 7.36\u003c/b\u003e 95%CI (2.35\u0026ndash;23.10) p\u0026thinsp;=\u0026thinsp;0.001] had higher likelihood for remaining in care, compared to other models, likely due to improved adolescent friendly services.\u003c/p\u003e \u003cp\u003eRegarding fidelity, table 5 provides the overall score. For the components measured, the total score was 80%, considered good fidelity.\u003c/p\u003e \u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5: Check list for fidelity scores\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"560\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 122px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDimension\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStrategy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStatus (Y/N)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRating (/10)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"bottom\" style=\"width: 122px;\"\u003e\n \u003cp\u003eAdherence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 208px;\"\u003e\n \u003cp\u003eKenyan team engaged\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 116px;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 114px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 208px;\"\u003e\n \u003cp\u003eCaregiver workshops conducted\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 116px;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 114px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 208px;\"\u003e\n \u003cp\u003ePeers and health workers oriented/trained on OTZ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 116px;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 114px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 208px;\"\u003e\n \u003cp\u003eMonthly OTZ meetings conducted\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 116px;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 114px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 122px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\" style=\"width: 122px;\"\u003e\n \u003cp\u003eDosage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 208px;\"\u003e\n \u003cp\u003eCaregiver meeting held for at least 2 times\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 116px;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 114px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 208px;\"\u003e\n \u003cp\u003eMonthly held for at least six times\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 116px;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 114px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 122px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"bottom\" style=\"width: 122px;\"\u003e\n \u003cp\u003eQuality of intervention delivery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 208px;\"\u003e\n \u003cp\u003eContinuous quality improvement projects implemented\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 116px;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 114px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 208px;\"\u003e\n \u003cp\u003eProject Monitoring and evaluation done\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 116px;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 114px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 208px;\"\u003e\n \u003cp\u003eSupport supervision done\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 116px;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 114px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 122px;\"\u003e\n \u003cp\u003eTotal score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 114px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Discussion","content":"\u003cp\u003e Our study adapted and evaluated the contribution of operation triple zero (OTZ) to improving both retention in care and HIV viral load suppression rate among the adolescents aged 10\u0026ndash;19 years old. After one year post implementation, viral load suppression improved from 84\u0026ndash;92.7% while retention also slightly improved from 96\u0026ndash;97%. The improvement in VLS rhymes well with findings from Nigeria (92%) and Ethiopia (92%) [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Overall, these achievements were better than previous reports. For VLS, the 92.7% was better than the 69% and 80% respectively reported in Mbale, eastern Uganda, and 81% in Kabale, southwestern Uganda [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. On the other hand, the retention rate was much higher than the 65.7%, 87% and 90% reported previously in Uganda [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. VLS typically requires provision of optimal ART and adherence[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e] both of which appear to have improved during the OTZ implementation, similar to what has been reported elsewhere [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Uganda implements a test and treat all policy with DTG-based regimens as the preferred anchor drug widely available across all HIV clinics in the country [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe improvement in VLS is attributable to the intervention which essentially led to improved adherence. Poor adherence had been identified earlier by health workers, caregivers and adolescents themselves as a key barrier to viral load suppression [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Fortunately, achieving optimal adherence is one of the principle objectives of the OTZ, through empowering of both caregivers and the ALHIV [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] in order to attain zero missed pills. The monthly and quarterly engagements of ALHIV and their caregivers respectively, were aimed at improving adherence through counselling, sharing experiences, designing personal improvement plans and addressing the question of social support systems. Also, there were additional deliberate efforts to improve adherence such as regular phone calls to offer virtual adherence support, greater involvement of the peers, supporting disclosure of HIV status to the adolescents, celebrating those who re-suppressed and home-based counselling in collaboration with the OVC team. These interventions were guided by the identified barriers and facilitators to VLS [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Improved adherence through enhanced counselling has been found to improve viral load suppression rates among PLHIV by up to 82% [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Therefore, OTZ likely enabled an interplay of various adolescent friendly health services provided, which greatly improved the positive outlook to life and treatment literacy among both caregivers and the adolescents.\u003c/p\u003e \u003cp\u003eRelatedly, ALHIV who received their care through facility-based groups were more likely to suppress their viral load and remain in care. Differentiated service delivery is a person-centered approach that enables PLHIV to receive care from their preferred models [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. It has been promoted as a key intervention for improving patient experience and onward treatment outcomes including viral load suppression [\u003cspan additionalcitationids=\"CR40\" citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. Facility-based groups (FBG) include generally stable individuals who receive services as cohorts including children, adolescents, pregnant and breastfeeding women[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. During the intervention period, ALHIV in the FBG received continued adherence support through peer-driven counselling, experience sharing with individuals who had suppressed their viral loads declaring their initiatives to attain sustained VLS status and also, caregiver literacy through health education. Indeed, social support groups have been reported to contribute to improved treatment outcomes [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFurther, ALHIV who received multi-month dispensing (MMD) of drugs had significantly better odds of attaining VLS during the intervention, similar to findings by Ainembabazi et al. [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Receiving drugs for at least three months enables PLHIV to adhere well for long because of sustained availability of the pills. However, ongoing counselling is important to strengthen adherence while clients are away from the clinics for long in order to sustain viral load suppression [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. In this study, only 0.6% had received drug refills for less than three months during their last clinic visit. With the odds of up to 11.5 to achieve viral load suppression, this finding should therefore encourage health workers who are currently hesitant to implement MMD among ALHIV, to confidently do so. As reported elsewhere, MMD reduces work/study interruptions, saves people\u0026rsquo;s time, reduces workload on the health workers, improves adherence and a good antidote to stigma and discrimination [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWhereas association of gender and viral load suppression has been found to be mixed, our study found males were less likely to attain a suppressed VL compared to the females, consistent with findings from Uganda, South Africa, Zimbabwe and Kenya [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. This could be due to negative peer influence, reluctance of males to seek and/or utilize healthcare services [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e], gross internal stigma, inadequate social support and absence of male-friendly services in the facilities [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. There is need to identify and address male specific issues in order to improve treatment outcomes by providing targeted interventions.\u003c/p\u003e \u003cp\u003eFinally, we acknowledge important study strengths such as: using routine program data likely reflects realities on the ground, use of RE-AIM offered a standardized way of conducting the evaluation, and a good study design that enabled us to compare the pre-and post-intervention periods. Conversely, study limitations included: implementation in COEs only, limiting potential applicability in public health sites. Whereas the setting maybe different, the same ministry of health package is implemented across all facilities in Uganda. Thus, the findings may yet be applicable across board despite the few variations. Also, only few ALHIV directly benefited from the model, limiting its potential wider effect on treatment outcomes. Despite this, all the adolescents benefitted from the intervention secondarily through improved skills from the health workers which led to enhanced implementation of adolescent friendly services including HIV status disclosure, differentiated service delivery and multi-month dispensing of drugs. Suffice to mention that while there were no policy changes during the implementation period, other contributing enhancers such as quality improvement and OVC models strengthened the intervention. Important to note that the intervention improved the implementation of the OVC in the settings.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eOverall, OTZ improved retention and VLS in the setting due to implementation of adolescent friendly health services such as MMD, various DSDMs which improved the adherence considerably. We envisage that OTZ has the potential to improve person-centered care for the adolescents by individualizing care, empowering the service providers and caregivers as well.\u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section2\"\u003e \u003ch2\u003eRecommendations\u003c/h2\u003e \u003cp\u003eWe recommend a wider implementation of the model in Uganda to close the current VLS gaps among the adolescents living with HIV. Through this model, adolescent health friendly services such as multi-month dispensing, and community-based differentiated models can be scaled up to address poor treatment outcomes.\u003c/p\u003e \u003c/div\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eALHIV\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAdolescent living with HIV\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eART\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAntiretroviral therapy\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAYPLHIV\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAdolescents and young people living with HIV\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCATS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCommunity adolescent treatment supporter\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCCLAD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCommunity client-led ART Delivery\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCDDP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCommunity Drug Delivery Points\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCOE\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCenter of Excellence\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eDSDM\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eDifferentiated Service Delivery Model\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eDTG\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eDolutegravir\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eFBG\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eFacility-based group\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eFBIM\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eFacility-based Individual Management\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eFTR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eFast-track refill\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eGEE\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003e \u003cb\u003eGeneralized Estimating Equations\u003c/b\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMMD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003emulti-month dispensing\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eOR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eOdds Ratio\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eOTZ\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eOperation Triple Zero\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eOVC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eOrphaned and Vulnerable Children\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePLHIV\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePeople living with HIV\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eRE\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAIM-Reach, Effectiveness, Adoption, Implementation and Maintenance\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eRNA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eRibonucleic acid\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eTASO\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eThe AIDS Support Organization\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eVLS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eViral load suppression\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eWHO\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eWorld health organization\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eYAPS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eYouth and adolescent treatment supporter\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical Consideration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study received ethical approval from TASO institutional review board (TASO‑ REC‑2022\u0026ndash;176) and the Uganda National Council of Science and Technology (UNCST), registration number \u003cstrong\u003eSS1610ES\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBO: Scientific direction, protocol development, resource mobilization, methodology design, interpretation of results, manuscript drafting, and overall coordination. AK, CA, BB, TMN, DK and SMS contributed to developing the protocol, methodology design and writing the draft manuscript. ENM contributed to protocol development, reviewed the manuscript and mobilized resources. EBM, KM and YM reviewed the final draft and contributed significant input to the work. AIO: methodology design and data analysis. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was funded by the International Pediatric HIV Symposium in Africa (IPHASA) of the International AIDS Society (IAS), grant number 0184.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe appreciate the study participants, IPHASA team for technical and logistical support, staff of TASO Mbale and Soroti COEs as well as management of TASO Uganda for their invaluable contributions.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization: Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection. (2016).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBonner K, Mezochow A, Roberts T, Ford N, Cohn J. 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BMC Health Serv Res. 2023;23:1\u0026ndash;19. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12913-023-09549-7\u003c/span\u003e\u003cspan address=\"10.1186/s12913-023-09549-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOkonji EF, van Wyk B, Mukumbang FC, Hughes GD. Determinants of viral suppression among adolescents on antiretroviral treatment in Ehlanzeni district, South Africa: a cross-sectional analysis. AIDS Res Ther. 2021;18:1\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12981-021-00391-7\u003c/span\u003e\u003cspan address=\"10.1186/s12981-021-00391-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKING\u0026rsquo;ORI BM. 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Moi Univ. 5\u0026ndash;24 (2020).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"aids-research-and-therapy","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"arty","sideBox":"Learn more about [AIDS Research and Therapy](http://aidsrestherapy.biomedcentral.com/)","snPcode":"12981","submissionUrl":"https://submission.nature.com/new-submission/12981/3","title":"AIDS Research and Therapy","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Operation Triple Zero, Viral Load suppression, retention, adolescents, RE-AIM, TASO","lastPublishedDoi":"10.21203/rs.3.rs-5883059/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5883059/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eIntroduction\u003c/h2\u003e \u003cp\u003eAdolescents living with HIV (ALHIV) aged 10\u0026ndash;19 years endure sub-optimal viral load suppression (VLS) and retention in care in many settings. We implemented operation triple zero (OTZ) in The AIDS Support Organization (TASO) Soroti and Mbale Centers of Excellence (COEs) to improve VLS and retention. Thus, this study evaluated the contribution of OTZ to improving both treatment outcomes among the ALHIV in the two COEs at one year.\u003c/p\u003e\u003ch2\u003eMethodology\u003c/h2\u003e \u003cp\u003eThis before and after study used Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework to guide secondary data collection from the cohort of ALHIV active in care in the April-June 2022 quarter. Effectiveness was determined by computing the overall VLS rates basing on plasma RNA copies below 1000/ml while retention was based on being active in care at the end of June 2024. A self-report was used to gather fidelity data. Univariates were summarized as frequencies and proportions, Generalized Equation Estimate (GEE) to compute the effect of the model and associated factors at 95% confidence interval and P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 level of significance. Odds ratio was used to report levels of predictability.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eOut of the original 533 ALHIV, 510 were considered for the post-intervention analysis, 53.1% females, mean age of 15.27 (Standard deviation\u0026thinsp;=\u0026thinsp;2.15). Overall, retention at 12 months improved from 95.9\u0026ndash;97.3% while VLS from 84\u0026ndash;92.7% [adjusted OR 1.26 95%CI (0.61\u0026ndash;2.61) P\u0026thinsp;=\u0026thinsp;0.036]. Importantly, there was zero death in the one year of implementation. After adjusting for confounders, adolescents in the facility-based group (FBG) were more likely to be retained in care [adjusted odds ratio (aOR)7.36 95% CI (2.35\u0026ndash;23.10) P\u0026thinsp;=\u0026thinsp;0.001]. Also, multi-month dispensing [aOR 11.65 95%CI (2.93\u0026ndash;46.34) P\u0026thinsp;\u0026lt;\u0026thinsp;0.001] and being in FBG [aOR 9.87 95%CI (4.08\u0026ndash;23.88) P\u0026thinsp;\u0026lt;\u0026thinsp;0.001] and community-based models [aOR 21.96 95%CI (2.68-179.84) P\u0026thinsp;=\u0026thinsp;0.004] were predictive of good VLS while poor adherence [aOR 0.02 95%CI (0.0037-0.11) P\u0026thinsp;\u0026lt;\u0026thinsp;0.001] and being male [aOR 0.5 95%CI (0.27\u0026ndash;0.91) p\u0026thinsp;=\u0026thinsp;0.024] were predictors of poor VLS. Fidelity was good, at 80%.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eOTZ contributed to improved VLS in the setting possibly due to fidelity of enhanced implementation of adolescent friendly health services. We encourage OTZ adaptation in similar settings to strengthen improvements in VLS.\u003c/p\u003e","manuscriptTitle":"Evaluating the contribution of Operation triple zero to HIV viral load suppression and retention among the adolescents in TASO Uganda using RE-AIM framework: a before and after implementation science study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-17 09:48:48","doi":"10.21203/rs.3.rs-5883059/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Accepted","date":"2025-05-09T04:30:17+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-08T09:54:47+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-08T04:47:46+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"339078583118987908345237285215575543595","date":"2025-04-21T02:32:21+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"310003408685867193778876205262819920965","date":"2025-04-17T14:25:55+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-04-16T11:52:46+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-07T10:52:33+00:00","index":"","fulltext":""},{"type":"submitted","content":"AIDS Research and Therapy","date":"2025-04-06T09:03:36+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"aids-research-and-therapy","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"arty","sideBox":"Learn more about [AIDS Research and Therapy](http://aidsrestherapy.biomedcentral.com/)","snPcode":"12981","submissionUrl":"https://submission.nature.com/new-submission/12981/3","title":"AIDS Research and Therapy","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"60568000-0950-49dd-a468-b6867375a2fe","owner":[],"postedDate":"April 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-05-26T16:08:48+00:00","versionOfRecord":{"articleIdentity":"rs-5883059","link":"https://doi.org/10.1186/s12981-025-00750-8","journal":{"identity":"aids-research-and-therapy","isVorOnly":false,"title":"AIDS Research and Therapy"},"publishedOn":"2025-05-20 15:57:27","publishedOnDateReadable":"May 20th, 2025"},"versionCreatedAt":"2025-04-17 09:48:48","video":"","vorDoi":"10.1186/s12981-025-00750-8","vorDoiUrl":"https://doi.org/10.1186/s12981-025-00750-8","workflowStages":[]},"version":"v1","identity":"rs-5883059","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5883059","identity":"rs-5883059","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}