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 antiretroviral

therapy (ART) programmes globally. The factors associated with the LTFU still

remain a challenge to many countries, becoming a critical barrier to effective scaleup

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. UNAIDS

targeted to achieve 90% in three key areas of HIV: identification in HIV positive

patients; prompt linkage to treatment; and viral suppression by the year 2020. The

second and third strategy has not been met in Nakuru West Sub-County. The Sub-

County has had increasing incidences of HIV and AIDS co-morbidities with drug

resistance. This study aimed at determining predictors of LTFU among adult patients

initiated on ART in Nakuru County health facilities. A retrospective cohort study design

was employed and 1131 participants enrolled/initiated on ART within 1st January

2016 to 31st December 2018 in the County Referral hospital, Kapkures and

Rhonda health centers were examined to determine their outcomes. Baseline patient

records were extracted from Electronic Master Facility and ART Cohort registers.

Survival data analysis was done using cox regression analysis besides to the descriptive

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 were analyzed using

standard qualitative method, to identify content and themes where the researcher

made claims on evidence in the data provided. From the results, a total of 1131 participants

contributed to 2094.6 PYs of follow up time with an overall LTFU incidence

rate of 161.1 (95%CI: 144-7 – 179.2) per 1000 PYs (337/1131). Four predictive

variables were statistically identified as significant to LTFU in the final Cox Regression

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