Community client-led anti-retroviral therapy delivery for people newly diagnosed with HIV: a pilot study in Nakivale Refugee Settlement in Uganda

Engaging in HIV care services can be challenging for refugees as they navigate new care systems while meeting daily needs. This pilot study assessed Early Community Client-led ART Delivery (Early CCLAD) as a differentiated care strategy for those newly diagnosed with HIV in Nakivale Refugee Settlement, Uganda. Early CCLAD was a community antiretroviral therapy delivery option where group members take turns coming to the health center. Adults accessing routine HIV testing were offered participation in the study. Participants completed intake surveys, and those interested in joining a community group received the intervention when feasible. The primary outcome was linkage to HIV clinical care within 90 days. Exit interviews were conducted to identify program benefits and challenges. Out of 2793 individuals enrolled, 92 tested positive for HIV and 74 (80.4%) were willing to participate in Early CCLAD. After 6 months, all participants in Early CCLAD groups had initiated ART and 87.0% achieved viral suppression. Convenience, social support and community building were identified as program benefits, while challenges included member commitment, reliability and mobility. Early CCLAD demonstrated feasibility and acceptability as an intervention strategy in a refugee settlement. Further research is needed to assess the scalability and long-term outcomes.