Factors associated with retention in care among HIV positive adults attending Pumwani comprehensive care Centre, in Nairobi County, Kenya

Abstract

Despite the benefits of antiretroviral therapy for persons with human immunodeficiency virus, various obstacles contribute to poor engagement in HIV care, substantially limiting the effectiveness of efforts to improve health outcomes for those with HIV and to reduce new HIV transmissions. A cross-sectional descriptive study design employing quantitative and qualitative data collection was used to determine factors associated with retention in care among HIV-positive adults in Pumwani comprehensive care Centre located in Kamukunji Sub County in Nairobi County. Data collection tools were structured questionnaire and focus group discussion. Systematic sampling was used to get a sample size of 350 participants (aged 18 years and above) and purposive sampling used in selecting 18 participants in the focus group. Data was analyzed using SPSS software and descriptive statistics generated. In addition, chi square test and logistic regression analysis were used to determine the factors associated with retention in HIV care. Notes from the focus group discussions were transcribed, translated, coded, analyzed thematically and presented in verbatim. The study received ethical approval from Kenyatta National Hospital/University of Nairobi ethical review committee. Participants signed an informed consent. Findings show that proportion of retention in care was at 66.8% with 73.5% being female. Of those retained, 70.3% were aware testing occurs at a health care provider point and 75% knew they were to be linked successfully within 3 months of diagnosis, while 70.7% knew they were to see a health provider at least four times in a year. Those who knew that HIV diagnosis could be diagnosed by a health provider were two times likely to be retained (OR 2.057, p=0.028), while if one is on ARVs they have four times chance of being retained (OR 3.994, p< 0.001). Participants in the focus group agreed that most clients discontinued care during the pre-ART period and competing life activities affected attendance of scheduled appointment. This study concludes that despite free access to ART services, retention in care is still a challenge. Competing life activities affects attendance to scheduled clinic appointments, while being on ARVS and testing done by a health provider are facilitators of retention in care. This study recommends adoption of community model for ART distribution, to lower chances of missed appointments and supports all HIV infected individuals to be on ARVS.