Analysis of retention incare among HIV patients in selected health care facilities in Zambia 2013-2015

Abstract

An estimated 2 million people are being newly infected, and 1.2 million people are dying of Human Immune Virus (HIV) – related causes (WHO, 2015). Despite significant success in scaling up Anti-retroviral Therapy (ART) programmes worldwide, many people living with HIV (PLHIV) start ART late in the progression of HIV infection, resulting in high rates of early mortality on ART. Poor retention of patients in care – especially in ART is a major driver of poor programme performance and increased morbidity and mortality. The objective of this study was to determine proportion and factors that may be associated with retention among HIV patients in Care in Zambia. This was a mixed design study which included ART patients retained on ART between the year 2013 and 2015 (n=61,111). The study was conducted through a health facility survey and a nested retrospective cohort to determine proportion and factors associated with ART patients who were retained on ART after initiation in 90 days in HIV Care. The study used test of two proportions and chi-square to describe the relationship between retention, age, sex, HIV status, enrolment in HIV care and ART initiation. The study showed that retention for the period 2013-2015 (36 month) stood at 69.3% at (95% CI: 68.9, 69.6). The finding were that male adult retention stood at 66.1% (95% CI: 65.5, 66.8) while female adult retention was 71.8% (CI: 71.3, 72.3) and pediatrics at 66% (95% CI: 63.7, 66.3). These findings were statistically significant with a p-value of p<0.0001. The study also showed mortality at 40/1000 per-month of follow-up (p-m of fu) (CI: 39.2, 41.3) while Lost to Follow-up (LTFu) was registered at 97/1000 p-m of fu/1000 (95% CI 95.4, 98.7). Results showed that retention in care among HIV patients in 12 month in selected health care facilities accounted for 80% of the total clients enrolled on ART. Lost to follow up and Mortality are key factors affecting retention. Male adults and pediatrics, were associated with an increased risk of attrition (LTFu 104.2/1,000(101.4, 107), 106.2/1,000(100.2, 112.1) and Mortality: 52.1/1,000(50, 54.1), 43/1,000(39.5, 47.4)) respectively. The study has shown that Zambia retention in care stands at 69% with low retention in key demographic characteristic such as male adults and pediatrics both recorded at 66%. Retention of 69% has a negative implication to the country attaining epidemic control as this leaves the larger v population vulnerable to infection transmission. Having established that male adults and pediatric variables are predictors affecting increased risk of attrition, the need to address factors affecting retention becomes important. This is by establishing policy that clearly addresses the most affected group that directly affects the larger population. Male adults and pediatric variables were predictors of retention that resulted in an increase in LTFu and Mortality factors. The study showed that identifying which clients are at greatest risk for not being retained is important to target intervention efforts to these groups. The findings suggest the need for health care to be decentralized and focused on delivering service at home based therapy level. This is where direct contact with gender and age is established. Chances of affecting male and pediatrics that have been associated with poor retention will reduce the risk of attrition. Interventions like these have a greater effect in complimenting other interventions such as socio-economical characteristics and other social determinants. Keywords: Retention, Attrition, Lost to follow-up, Mortality, Transfers and Anti-Retroviral Therapy (ART)