Determinants of adherence to scheduled medical appointment among HIV infected children aged 18 months to nine years receiving care at Kenyatta National Hospital, Kenya

Abstract

Adherence to scheduled medical care appointment among human immunodeficiency virus (HIV)–infected children has been found to be associated with positive health outcomes. The objectives of this study was to establish determinants of adherence to scheduled medical appointment among HIV infected children aged 18 months to nine years receiving care at Kenyatta National Hospital (KNH), Kenya. This was a prospective cohort study involving 221 participants who were primary care givers and their HIV infected children. Study conducted from March, 2017 to November, 2018. Each participant was followed for period of 12 months. Data was collected using pretested questionnaire and review of standardized clinical notes on adherence to scheduled medical appointments and determinants of adherence to scheduled medical appointments. Two focus group discussions (FGDs) consisting of 8 purposively sampled primary care givers were undertaken to support the quantitative findings. The analysis of quantitative data was done using Statistical Package for Social Sciences (SPSS) Version 20. Analysis for association between adherence to scheduled medical appointment and determinants factors were done on both univariate and multivariate analysis, Data from focused group discussions was analysis based on themes. Informed consent was obtained and signed by primary care givers of the children voluntary. Confidentiality and privacy was maintained. Ethical approval no P688/09/2016) was obtained. This study found adherence to scheduled HIV medical appointment among study participants to range from 75.6% to 81.9% at 6 and 12 months respectively. The higher the CD4 counts the lower the likelihood of adherence to scheduled medical appointments. At 12 months of follow up there was an increasing trend for higher odds of missing scheduled medical appointments with an increase in CD4 counts aOR 19.32 (95% CI 2.73 – 136.78) CD4 1000 –1499; 21.48 (95% CI 3.64 – 126.62) CD4 >=1500 when compared to children with <500 CD4 count. Children clinical factors associated with adherence to scheduled medical appointment at 12 months of follow up were; receiving HIV treatment in the scheduled health facilities and having lower CD4 cell counts. Children primary care givers perceived HIV care services as very beneficial to the health of their children. Determinants of adherence to scheduled medical appointments among HIV infected children are low CD4 cell counts, receiving HIV treatment at the scheduled health facilities. Care givers perception on HIV care services provided to their HIV infected children as very beneficial to their health. Children with high CD4 counts should be targeted by Health care providers for individualized intervention to ensure they adhere to all scheduled medical appointments. Ministry of health and HIV policy makers to emphasize that all children to receive HIV treatment in the scheduled health facility by enhancing it in policies that deals with HIV prevention and differentiated care model for people living with HIV.