Comparison of loss to follow-up amongst HIV and AIDS patients in care and treatment in Kisumu, Kenya
Background: Even though there have been marked increases in the number of patients accessing HIV care and treatment in sub-Saharan Africa, challenges in patient retention remain. Most health systems in sub-Saharan Africa routinely report on loss to follow up of patients, but only a limited number of factors associated with loss to follow up are measured. In Kenya there is limited research on loss to follow up in HIV care and treatment programs. This study reports on rates of loss to follow up and factors associated with loss to follow up at the New NyanzaProvincial General Hospital (NNPGH) in Kisumu, Kenya. Methods: A retrospective cohort study of 4,740 adult patients that was registered for HIV and AIDS care and treatment between 2003 and 2008 was conducted. Data was analysed using SAS 9.2 and STATA 10. Cox proportional hazard ratio was calculated to describe the association between risk factors and loss to follow up. Results of the total 4740 patients, 64.6% were female, males [median age of 36 (IQR 30-44) years vs. 32 (IQR 26-39) years for females] were older than females, more males (68.3%) were married, more females (6.2%) had no education and 68% of all patients enrolled had been lost to follow up over 6 years. Risk for lost to follow up was greater amongst males (Adjusted Hazard Ratio (AHR) =1.12; 95% Confidence Interval (CI) = 1.02-1.22); younger patients(15-30 vs. >40 years: AHR=1.37, 95%CI = 1.23 – 1.53; and 31-40 vs. >40 years: AHR=1.15, 95%CI=1.03-1.28); those who were unemployed (AHR=1.14, 95%CI=1.05-1.25); and having advanced HIV disease (WHO stage 4 vs. WHO stage 1: AHR=1.53, 95%CI=1.29-1.81). Patients on ART (AHR=0.64, 95%CI=0.52-0.78) at enrollment were less likely to be lost to follow-up compared to those in HIV care. Conclusion: More attention is needed in developing retention strategies for patients with much focus on patients on care. Targeted intervention is required to improve retention amongst males, unemployed patients, patients with advanced HIV disease and younger patients. Additionally, targeted follow up in the community for patients on care is required.