Abstract:
Acquired immune deficiency syndrome remains one of the most destructive
epidemics the world has ever witnessed. Declaration of HIV infection as a national
disaster in Kenya led to increased resource allocation and mobilization towards
prevention care and treatment of HIV and AIDS. The rollout of prophylaxis and
antiretroviral therapy has brought lifesaving treatment to millions of HIV-infected
individuals. Advocacy and increased HIV testing and counseling coupled with
availability of HIV care and treatment services has increased the uptake of HIV
services in health facilities. HIV treatment is life-long and to continue the benefits,
patients must remain in care. Despite this, systematic investigations of retention have
documented high rates of loss to follow-up from HIV treatment programs. The main
objective of this study was to determine the patient and hospital factors associated
with loss to follow up among HIV positive patients in Comprehensive Care Clinic in
Referral Hospital. This was a Post hoc cross sectional study conducted in Kiambu
County referral hospital in 2014. HIV positive adult patients enrolled in care and
documented to have been lost to follow up according to case definition were
recruited. Pre-determined sampling was done to select patients who met inclusion
criteria, starting with the most recent patients until the sample size of 313 was
attained. Files of patients who were sampled had data abstracted and the patient were
then contacted on phone and structured questionnaires administered. The resultant
data was coded, cleaned, sorted and was analyzed using descriptive analysis where
proportions were calculated for categorical data and summarized into tables and
charts. Cross tabulations was applied to test for statistical association between
variables. The Pearson’s chi-square was used, where cell numbers were too small in
two by two tables, the Fishers exact test and Odds ratios were applied. A p-value of
less than 0.05 indicated a significant statistical association. The study found that a
higher proportion of female (66.5%) than male (33.5%) was lost to follow up and
most patients had Primary level of education. Ninety five percent accepted their HIV
status and 95.5% had disclosed status to another significant person. The main reason
for LTFU in this study was transfer out, self-transfer out, death and relocation of
residence. Only 39.6% of clients who continued on treatment while LTFU from the
facility reported adherence to ART; forgetting to swallow their ARVs was the main
reason for non-adherence. Duration since knowledge of HIV status, treatment
supporter, support group, whether or not one was on ARVs, disclosure of status and
substance abuse were associated with LTFU. Strengthening service delivery systems
through electronic data management, efficient patient tracking and patient centered
model of care are recommended for the HIV clinic to mitigate against LTFU of
patients from the facility.