<p>Study time periods of interest.</p>

Kidney disease affects 850 million people worldwide, with Sub-Saharan Africa bearing a significant burden. People living with HIV (PWH) are at increased risk due to nephrotoxicity of antiretroviral therapy (ART), in part due to widespread use of tenofovir disoproxil fumarate. In response, Uganda recommends routine kidney disease screening by doing a serum creatinine test at ART initiation. However, the extent of adherence to these guidelines remains poorly understood. We extracted clinical data for adults initiating ART between 2017 and 2024 at three large-volume HIV clinics in Uganda. To determine if kidney disease screening rates had increased appropriately over time, we divided the observation period into three eras as per national guidelines: (1) Test and Treat (2017–2019), that recommended screening only PWH and diabetes or hypertension; (2) DTG rollout/COVID-19 (2020–2022); and (3) creatinine-for-all (2023–2024), recommending screening everyone initiating ART. Logistic regression models were fit to identify correlates of renal screening. Of the 17,485 participants, only 22.4% (3,909/17,485) were screened for kidney disease at ART initiation. Screening was more common at the urban site (54.2%) compared to rural sites (10.0%). At rural sites, screening declined over time and individuals were 83% less likely to be screened in the creatinine-for-all era compared to the baseline era (aOR 0.17, 95% CI: 0.13–0.22) while it increased at urban site (aOR 9.27, 95% CI: 7.37–11.66). Male sex (aOR 1.37, 95% CI: 1.20–1.57), older age (≥45 years), hypertension, and non–TDF-based ART regimens were associated with higher screening odds at rural sites. Diabetes, opportunistic infections, and TDF use were not significantly associated with screening likelihood at any site. Kidney disease screening for PWH at ART initiation remains poor in Uganda, even when using a single creatinine test, particularly in rural clinics, highlighting critical challenges in translating national guidelines into practice. Future research should focus on understanding multilevel barriers to screening and evaluating strategies to improve guideline uptake.全球约有8.5亿人群遭受肾脏疾病的困扰，撒哈拉以南非洲地区承担了极为沉重的疾病负担。人类免疫缺陷病毒感染者（People living with HIV, PWH）因抗逆转录病毒治疗（antiretroviral therapy, ART）的肾毒性作用，罹患肾脏疾病的风险显著升高，这一现象在一定程度上与富马酸替诺福韦二吡呋酯（tenofovir disoproxil fumarate, TDF）的广泛临床应用相关。 为此，乌干达国家指南推荐在患者启动ART治疗时，通过血清肌酐检测开展常规肾脏疾病筛查。但目前针对该指南的临床执行依从性程度仍鲜为人知。 本研究提取了2017至2024年间，乌干达三家大型HIV诊疗中心中启动ART治疗的成年患者的临床数据。为评估肾脏疾病筛查率是否随时间得到合理提升，研究团队依据国家指南将观察周期划分为三个阶段： 1. 检测即治疗（Test and Treat, 2017–2019）阶段：仅推荐对PWH合并糖尿病或高血压的人群开展肾脏疾病筛查； 2. 多替拉韦（dolutegravir, DTG）推广/新冠疫情（2020–2022）阶段； 3. 全民肌酐筛查（creatinine-for-all, 2023–2024）阶段：推荐对所有启动ART治疗的患者进行肾脏疾病筛查。 研究采用逻辑回归模型，以明确肾脏疾病筛查的相关影响因素。在纳入的17485名研究对象中，仅22.4%（3909/17485）的患者在启动ART治疗时接受了肾脏疾病筛查。城市诊疗中心的筛查率（54.2%）显著高于农村诊疗中心（10.0%）。农村诊疗中心的筛查率随时间推移呈下降趋势：与基线阶段相比，全民肌酐筛查阶段的患者接受筛查的调整后优势比（adjusted odds ratio, aOR）为0.17（95%置信区间：0.13–0.22），即筛查概率降低83%；而城市诊疗中心的筛查率则呈显著上升趋势（aOR 9.27, 95% CI: 7.37–11.66）。 在农村诊疗中心中，男性（aOR 1.37, 95% CI: 1.20–1.57）、年龄≥45岁的患者、高血压患者以及采用非TDF方案的ART治疗者，其接受肾脏疾病筛查的调整后优势比更高。而糖尿病、机会性感染以及TDF的使用，在所有类型的诊疗中心中均与筛查概率无显著统计学关联。 乌干达地区PWH在启动ART治疗时的肾脏疾病筛查率仍处于较低水平，即便仅需开展单次血清肌酐检测，农村诊疗点的筛查现状尤为堪忧，这凸显了将国家临床指南转化为实际诊疗行为所面临的严峻挑战。未来研究应聚焦于解析筛查工作面临的多层次障碍，并评估提升指南执行率的有效干预策略。