The Incidence Rate and Health-Care Factors Associated with LTFU, among Adult Patients Initiated on ART in Nakuru West Sub-County Health Facilities, Kenya
Background: The successful strengthening of antiretroviral therapy (ART) programmes globally has been reversed by loss to follow up (LTFU). The factors associated with LTFU still remain gainsay to many countries including Kenya, a critical barrier to effective scale-up of human immunodeficiency virus (HIV) services. Kenya is one of the four HIV high burden countries in Africa (alongside Mozambique and Uganda) with 29% adult HIV co-morbidities, overburdening the health care system and the country’s 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 have not been met in Nakuru West Sub-County. This study aimed at determining the incidence rate and health-care factors associated with LTFU, among adult patients initiated on ART in Nakuru West Sub-County health facilities. Methods: A retrospective cohort study design using mixed method of data collection was employed. Records of 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 for three years to determine their outcomes. Data was collected using abstraction form extracted from the standard ART cohort register and master facility register and from key informants. Recorded interviews were transcribed and analyzed using standard qualitative method, to identify content and themes. A total of 9 key informants working in the CCC/HIV clinics were interviewed upon consenting. Kaplan-Meier technique was used to estimate time to LTFU after initiation of ART. Results: The overall incidence rate of 1611 (95% CI: 114.7 - 179.2) per 1000 person-years was revealed. In addition, the following variables were identified in the qualitative findings to be associated with LTFU: wrong/poor documentation, long waiting time, approaches in the implementation of the HIV/AIDS management policies (“Test and Treat” and “defaulter tracing”) and inadequate funds to support staffing and to manage support groups. Conclusions and Recommendations: In order to minimize LTFU and met UNAIDS targets, interventions should be geared towards close follow up supervision of all CCC patients by capturing correct contact addresses and updating patient records. In addition, this study recommends that, the Ministry of Health, Nakuru County Government, APHIA-PLUS and all other stakeholders should build capacity of health care personnel to improve provision of HIV care services, ensure availability of adequate resources and address challenges that impede the implementation of HIV and AIDS management policies, especially for newly enrolled patients who may not be prepared to start treatment or unwilling to disclose their status. This will, in turn, curb LTFU, enhance patient retention, patient survival and improve quality of life.
Cite this paper
Kibet, G. J. , Arudo, J. , Ashivira, C. , Lopar, S. K. , Ogendo, R. , Kabutbei, L. and Sakwa, G. (2022). The Incidence Rate and Health-Care Factors Associated with LTFU, among Adult Patients Initiated on ART in Nakuru West Sub-County Health Facilities, Kenya. Open Access Library Journal, 9, e8303. doi: http://dx.doi.org/10.4236/oalib.1108303.
Salema, J. (2015) Factors and Challenges Associated with Loss of Follow up Visits among HIV and AIDS Clients Attending Antiretroviral Therapy in Ilala Municipal Council. Masters’ Thesis, Mzumbe University, Dar es Salaam.
Berheto, T.M., Mohammed, S. and Haile, B.D. (2014) Predictors of Loss to Follow Up in Patients Living with HIV/AIDS after Initiation of Antiretroviral Therapy. North American Journal of Medical Sciences, 6, 453-459.
https://doi.org/10.4103/1947-2714.141636
Evangeli, M., Newell, M. and McGrath, N. (2016) Factors Associated with Pre-ART Loss-to-Follow-up in Adults in Rural KwaZulu-Natal, South Africa: A Prospective Cohort Study. BMC Public Health, 16, Article No. 358.
https://doi.org/10.1186/s12889-016-3025-x
Seifu, W., Ali, W. and Meresa, B. (2018). Predictors of Loss to Follow up among Aduclients Attending Antiretroviral Treatment at Karamara General Hospital, Jigjiga Town, Eastern Ethiopia, 2015: A Retrospective Cohort Study. BMC Infectious Diseases, 18, Article No. 280. https://doi.org/10.1186/s12879-018-3188-4
De la Mata, N.L., Ly, S.P., Nguyen, K.V., Merati, T.P., Pham, T.T., Lee, M.P., et al. (2017) The Loss to Follow-Up Trends in HIV-Positive Patients Receiving Antiretroviral Treatment in Asia from 2003 to 2013. Journal for Immune Deficiency Syndrome, 74, 555-562. https://doi.org/10.1097/QAI.0000000000001293
Tweya, H., Oboho, I., Gugsa, S., Phiri, S., Rambiki, E., Banda, R., et al. (2018) The Loss to Follow-Up Before and after Initiation of Antiretroviral Therapy in HIV Facilities in Lilongwe, Malawi. PLoS ONE, 13, Article ID: e018848.
https://doi.org/10.1371/journal.pone.0188488
Tadesse, K. and Haile, F. (2014) Predictors of Loss to Follow Up of Patients Enrolled in Antiretroviral Therapy: A Retrospective Cohort Study. Journal of AIDS & Clinical Research, 5, Article No. 393.
Megerso, A, Garoma, S, Eticha, T., Workineh, T., Daba, S., Tarekegn, M. and Habtamu, Z. (2016) Predictors of Loss to Follow-up in Antiretroviral Treatment for Adult Patients in Oromia Region Ethiopia. HIV/AIDS: Research and Palliative Care, 8, 83-92. https://doi.org/10.2147/HIV.S98137
Grimsrud, A.T. (2015) The Loss to Follow-Up from South Africa’s Antiretroviral Treatment Programme: Trends, Risk Factors, and Models of Care to Improve Retention. Dissertation Thesis, School of Public Health and Family Medicine, University of Cape Town, Cape Town.
Saumu, W.M. (2017) The Magnitude and Factors Associated with Loss to Follow Up among Children Attending the HIV Clinic at Kang’undo Level Four Hospital. Masters’ Thesis, Kenyatta University, Nairobi.
Meloni Thakore, S., Chang, C., Chaplin, B., Rawizza, H., Jolayemi, O., Banigbe, B., et al. (2014) Time-Dependent Predictors of Loss to Follow-Up in a Large HIV Treatment Cohort in Nigeria. Open Forum Infectious Diseases, 1, Article No. ofu055.
https://doi.org/10.1093/ofid/ofu055
Mehari, M., Kiros, N., Yemane, A., Asghedom, N., Drbessay, S. and Tekeste, T. (2017) Factors Affecting Treatment Adherence among HIV Positive Patients in Eritrea. International, Biological and Biomedical Journal, 3, 150-156.
Clinical Guideline Antiretroviral Therapy. Consolidated Guideline on the Use of Antiretroviral Drug for Treating and Preventing HIV Infection (2015). World Health Organization, Geneva.
Susich, M., Ulysse, P., Casseus, A., Michaelis, A. and Mukherjee, J. (2016) Giving Voice to Patients in Rural Haiti: An Assessment of Retention in HIV Care. Journal of AIDS & Clinical Research, 7, Article No. 553.
https://doi.org/10.4172/2155-6113.1000553
National AIDS and STI Control Programme (NASCOP) and Ministry of health (MOH) (2018) Turning the Tide: Preventing New HIV Infection & Optimizing Treatment Outcomes. 2018 HIV Prevention, Care & Treatment Scientific Conference, Nairobi, 9-12 September 2018, 1.
Agwu, A., Lee, L., Fleishman, J., Voss, C., Yehia, B., Althoff, K., et al. (2016) Aging and Loss to Follow-up among Youth Living with Human Immunodeficiency Virus in the HIV Research Network. Journal of Adolescence Health, 56, 346-351.
https://doi.org/10.1016/j.jadohealth.2014.11.009
Dessalegn, M., Tsadik, M. and Lemma, H. (2015) Predictors of Loss to Follow up in Antiretroviral Therapy in a Primary Public Hospital of Wukro, Tigray, Ethiopia: A Case-Control Study. Journal of AIDS & HIV Research, 7, 1-9.
https://doi.org/10.5897/JAHR2014.0315
Mberi, M., Kuonza, L., Dube, N., Nattey, C., Manda, S. and Summers, R. (2015) Determinants of Loss to Follow-up in Patients on Antiretroviral Treatment, South Africa, 2004-2012: A Cohort Study. BMC Health Service Research, 15, Article No. 259.
https://doi.org/10.1186/s12913-015-0912-2
Mukumbang, F., Mwale, J. and Wyk, B. (2017) Conceptualising the Factors Affecting Retention in Care of Patients on Antiretroviral Treatment in Kabwe District, Zambia, Using the Ecological Framework. AIDS Research & Treatment, 2017, Article ID: 7356362. https://doi.org/10.1155/2017/7356362