Factors associated with retention in HIV care in Wakiso District, Uganda from 2008 to 2010

Abstract

Since there is not cure for HIV/AIDS, United Nations member states embarked on efforts towards global access to adequate prevention plans, support and treatment by 2010. However, the effectiveness of HIV/AIDS treatment is subject to the retention in care of patients, which is defined as remaining connected to care and keeping all scheduled appointments. Retention in care was comparatively to this study defined as remaining connected to care and keeping scheduled appointments by attending at least one appointment in 2010. The health system considers the retention in care for patients who have initiated ART as crucial point for improving their immunological response, to prevent HIV resistance, to avoid drug treatment interruptions and to monitor the effects of therapy. The aim of this study is to identify factors associated with retention in care among HIV-infected patients who initiated care in primary health care centres and those who initiated care in hospital facilities in Wakiso District, Uganda from 2008 to 2010. Methods and material The present study was a secondary data analysis using data from the Wakiso project, a prospective cohort study carried out by MRC/UVRI & LSHTM Uganda Research Unit on AIDS in Uganda between 2008 and 2010. The study included all HIV positive patients from the 9 government health facilities who were included in the original Wakiso project (between 2008 and 2010). To compare retention in health care between HIV infected patients who initiated care in the primary health care clinics and HIV infected patients who initiated care in the hospital facilities in Wakiso district, Uganda 2008 to 2010. Descriptive analyses of the time to drop-out was carried out using survival analysis methods; the time to drop-out was graphically described using Kaplan Meier plots. To investigate factors associated with 5 retention in care among HIV infected patients who initiated care in the primary health care clinics and HIV infected patients who initiated care in the hospital; Cox regression models in Stata, version 15.1, were fitted. Results A total of 452 participants took part in the study and were all included in the final analysis. During the observation time, 21% (n=95) participants got lost to follow-up. The rate of getting lost to follow-up was 20.3 (95% CI: 16.6; 24.8) per 100 person-years. In the unadjusted model, the risk of loss to follow-up was 7 % higher from participants in peripheral health centres than those from the hospital/HC IV, although this association was not statistically significant (p=0.750) while in the adjusted model there was a statistically significant difference in the rates of getting lost to follow-up between the participants who received care from peripheral health center compared to those who received care at Hospital/HC IV. The risk of being lost to follow up was lower by 40% (HR=0.62; 95% CI [0.40; 0.96]) among participants who received care from peripheral health centre compared to received care at Hospital/HC IV after adjusting for sex and whether the patient had ever been or ART. In addition, there was overwhelming evidence to suggest that participants who had ever been on ART had an 80% lower risk of being lost to follow-up relative to those who had never been on ART (HR=0.19; 95% CI [0.12; 0.32]) and this was statistically significant (p-value<0.001). Discussion/Conclusion Our results suggest that there is a significant difference in retention in care between patients who initiated care in the peripheral health centre and those in the hospital facilities. When controlling for sex and whether the participant had been on ART, participants who were recruited from the Primary Health Centres were less likely to be lost to follow-up. In addition, 6 the result shows that patients are much more likely to be retained in care when they are on ART.