Determine factors to retention in care for HIV positive clients on art in Sioma district- western province, Zambia.

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Lyuba, Jones
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The University of Zambia
Introduction: Keeping clients in care is essential to achieving strong patient outcomes and prevent treatment failure or resistance. Globally, HIV/AIDS remains one of a major public health problems with an estimated 38.4 million people are living with HIV while 1.5 million people become newly infected with HIV annually. HIV/AIDS has continued to be a major public health challenge even for Zambia, with the highest HIV prevalence rate of 13.1% in sub-Saharan Africa. Although the government of Zambia has increased the availability of ARVs in all the health facilities in the country and ensured that all HIV positive clients are put and retained in ART by means of “Test and Treat” program, not all patients who are initiated on antiretroviral treatment remain in care; with some patients being lost at different points in the continuum of care. Hence, this study is aimed at determining several factors to retention in care for HIV positive clients and their outcome at 4 health facilities in Sioma District in Zambia. Methodology: This is a retrospective cohort study, from period February, 2020 to February 2023, used a systematic quantitative method of collecting information or data by reviewing pre-existing data of a sample of an individuals as well as by administering research questionnaires to HIV defaulters. To determine the geographical, sociocultural, Health systems and medical condition factors that underlie retention and its outcome in selected primary health facilities in the district. Sample size was calculated using Kaplan Meier formula with confidence interval of 95%. 360 defaulters were studied on and data was analyzed using Kaplan Meier curves and Log rank tests in STATA to determine the survival outcome of all defaulters over time. Findings: The overall retention rate of the ART sites was found to be 89% for client initiated 3 years ago. With reduced mortality survival rate of 86% from 100% of the non-defaulters, while the morbidity survival rate was at 39% compared to over 95% for non-defaulter clients. The median duration of follow-up was 18 months (0-41). At 12 months, the Date of Death-free survival was 85.7% (95% CI: 53.9-96.2) and at 24 months, the Date of Death-free survival was 38.6% (95% CI: 13.4-63.6). The survival rate for HIV defaulters reduced over time, as the defaulter rate increased over time. Most of the mortalities 67% (n=6) occurred within 12 months after stopping taking ARVs. This applies to the increase in the occurrence of Opportunistic Infections (OIs) over time after clients stopped taking ARVs. The majority developed OIs 93% (n=313) within 12 months, 100% of mortalities were associated with OIs. Geographical and sociocultural factors were the major contributors to poor retention in the district accounting for over 62%. 214 of all respondents stopped taking ARVs because of long distance (> 12 KMs) for drug pickups, while 6% (n=25) was due to floods and cut off reasons.
Thesis of Master of Public Health