Retention in HIV Care among Patients Testing Positive for HIV and Ineligible to Start Antiretroviral Therapy

Kenneth Anene Agu, Mohammed Alfa Isah, Dorothy Oqua, Rosalyn C. King, Anthony K. Wutoh

General Hospital Minna, Niger State, Nigeria.
Howard University Pharmacists And Continuing Education (PACE) Center, Abuja, Nigeria.
Howard University Pharmacists and Continuing Education (PACE) Center, Washington DC, USA.

DOI: 10.4236/wja.2012.24044                

Abstract

Background: The failure to monitor and link patients from HIV testing to HIV care and retain them in care until they are eligible for ART is a major barrier to early ART initiation. This study evaluated the retention in pre-ART care of HIV-positive patients who are ineligible to start ART in Nigeria. Methods: Out of 1766 ART-ineligible HIV-positive patients enrolled into pre-ART care (during 1^st March to 31^st December 2007), 1,098 patients were randomly selected for a five-year (ending 30^th April 2012) retrospective cohort assessment using routine data in two health facilities. Retention was defined as remaining connected to pre-ART care once entered until ART initiation or transfer-out to continue care elsewhere. Probability of retention was estimated using Kaplan-Meier survival method and log-rank test. Cox proportional hazards model was used for attrition and P < 0.05 used to determine statistical significance. Results: The mean age of participants was 33.1 (95% CI, 32.6 - 33.6) years old; and 65.1% were female. Patients were followed up for 512.6 person-years. Of the 59.0% patients retained, 93.8% started ART, 4.6% were transferred out to continue care elsewhere and 1.6% were active in care at the end of observation period. The retention rates at 1, 2, 3, 4 and 5 years observation period were 36.1 cases per 100 person-years, 17.4 cases per 100 person-years, 9.6 cases per 100 person-years, 3.7 cases per 100 person-years and 0.6 cases per 100 person-years respectively; the differences were statistically significant (P < 0.05). The mean estimate of patients' attrition time was 1.9 (95% CI, 1.7 - 2.1) years. Patients who started cotrimoxazole prophylaxis (CPT) at enrolment had significantly higher attrition time of 2.4 (95% CI, 2.1 - 2.7) years, compared to 0.9 (95% CI, 0.7 - 1.1) years for those not on CPT (P < 0.05). There was 54.0% reduction in risk of attrition among those who started CPT compared to those who did not [HR = 0.460, 95% CI: 0.321 - 0.660; P = 0.000]. Socio-demographic characteristics, CD4 cells count and WHO clinical stage at pre-ART enrolment were not associated with attrition (P > 0.05). Conclusion: Retention in pre-ART care was somewhat poor. Uptake of CPT significantly improved retention. Majority of attrition occurred in first year of pre-ART care. Close monitoring and tracking of patients during this period is recommended.

Keywords

Retention; Attrition; HIV Care; Patients; Nigeria

Conflicts of Interest

The authors declare no conflicts of interest.

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