Factors affecting long term retention of adult patients to chronic HIV care in Siaya and Bondo County Hospitals

Abstract

Background: Long term retention to HIV care is critical to reduce HIV related morbidity and mortality, reduce incidence of new infections and reduce development of antiretroviral therapy (ART) resistance. The main objective of this study was to assess factors affecting long term retention to HIV care in a HIV cohort in Bondo and Siaya. Methods: This was a retrospective cohort study conducted in Siaya and Bondo district hospitals. The study sampled 377 patients who were enrolled to care between 1st January 2010 and 1st July 2010. Long term retention was defined as remaining engaged in care for 24 months. Data was analyzed using SPSS computer software. Descriptive statistics was done for all variables. Bivariate analysis was done using Chi-Square test. Kaplan-Meier survival method was used to estimate probability of retention. Logistical regression model was used to predict determinants of long term retention. Results: The mean age of participants was 35.1 years (± 11.23); and 65% were female. After 24 months of follow-up after enrollment into HIV care, half (58.4%) of the patients were still active in care; 61 (16.2%) of the patients had transferred out to other facilities; 96 had either died (2.7%) or were lost to follow-up (22.8%). Using chi-square test, retention was significantly associated with: occupation status at enrolment( p= 0.030 ), WHO stage at enrolment( p =0.031), CD4 count at enrolment( p= 0.000) and marital status at enrollment ( p =0.024). Logistic regression analysis found, WHO stage 1 (AOR 3.611 95%CI 1.020-12.779 P=0.04) and CD4<200(AOR 0.304 95%CI 0.0106-0.873 P=0.03) were associated with increased and decreased likelihood of retention respectively. Conclusion and Recommendation: Only half the patients in care at Siaya and Bondo DH were retained in long term care. WHO stage 1 disease at enrolment was associated with increased likelihood of retention and CD4<200/uL was associated with decreased likelihood of retention, There is need to ensure early HIV diagnosis and linkage to care before deterioration of immune and clinical status. Targeted interventions for patients enrolling with advanced HIV disease are key to ensure they remain in care.