PREDICTORS OF LOSS TOFOLLOW UP AMONG ADULTPATIENTSIN-ITIATED ON ANTIRETROVIRAL THERAPY IN NAKURU WEST SUB-COUNTY HEALTH FACILITIES, KENYA

Abstract

The loss to follow up (LTFU) has reversed the successful strengthening of antiretro-viral therapy(ART) programmes globally. The factors associated with the LTFU still remain a challenge to many countries, becoming a criticalbarrier to effective scale-up of HIV services. Kenya is one of the four HIV high burden countries in Africa (alongside Mozambique and Uganda) with the retention rate of about 81% which is below the set 90%.The HIV prevalence in the country is at 5.9% with 29% adult HIV co-morbidities overburdening the health care system and economy.UNAIDStargeted to achieve 90% in three key areas of HIV: identification in HIV positive patients; prompt linkage to treatment; and viral suppressionby the year 2020.The second and third strategy has not been met inNakuru West Sub-County.The Sub-County has had increasing incidences of HIV and AIDS co-morbidities with drug resistance. This study aimed at determiningpredictors of LTFU among adultpatients initiated on ART in NakuruCounty health facilities. A retrospective cohort study de-sign was employed and 1131 participants enrolled/initiated on ART within 1stJanu-ary 2016 to 31stDecember 2018 in the County Referral hospital, Kapkures and Rhonda health centers were examined to determine their outcomes. Baseline patient records were extracted from ElectronicMaster Facility and ART Cohort registers. Survival data analysis was done using cox regression analysis besides to the descrip-tive statistics. Kaplan Meier (KM) curves were drawn to estimate the probability of LTFU and proportionality hazards assumption was checked for covariates intended to be included in the final cox mode. A total of 9 Key informants from identified CCC/HIV clinics were interviewed.The written interviews wereanalyzed using standard qualitative method, to identify content and themes wherethe researcher made claims on evidence in the dataprovided.From the results, a total of 1131 par-ticipants contributed to 2094.6 PYs of follow up time with an overall LTFU inci-dence rate of 161.1 (95%CI: 144-7 –179.2) per 1000 PYs (337/1131). Four predic-tive variables were statistically identified as significant to LTFU in the final Cox Re-gression model: Low BMI of 18.4, (AHR = 1.88; 95%CI: 1.40 –2.54; p < 0.0001); attending rural facility(AHR: 0.58; 95%CI: 0.36 –0.76); p < 0.0001); IPT users (AHR:1.34; 95%CI: 0.84 –1.57); p <0.0001) and high VL(AHR: 0.59: 95%CI: 0.17 –1.00); p < 0.0001). In addition, the key informants identified the following factors that contributed to LTFU: wrong documentation; long waiting time; inappropriate implementation of the HIV and AIDS management policies and inadequate funds.Tominimize LTFU andrealize the second and third UNAIDS/WHO HIV implementation strategies, interventions should be geared towards, close supervision all HIV adults with: CD4 <200 cells/mm3, high VL, attending rural facility and IPT-users.This studyalsorecommends that,the Ministry of Health, County government and all other stakeholdersshouldbuild capacity of health carepersonnel to improve provision of HIVcare services; they also need to address availability of resources and challenges that impede theimplementationof HIV and AIDS management poli-cies. This will, in turn, curb LTFU, enhancepatient retention, patient survival and improve quality of life.