Factors Associated with Loss to Follow Up of HIV Patients Living with HIV in Kiambu County Referral Hospital

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.