Retention of HIV positive person at antiretroviral therapy clinics in post-conflict Northern Uganda

Abstract

����Introduction Northern Uganda is experiencing a lull in a 20 year civil war that had led to the massive displacement of people from their homes. Majority of people living in internally displaced people’s camps are now returning to their homes. The HIV scourge in the region has been fanned by the war, exposing the population to a higher prevalence of 8.4 % as compared to the HIV country average of 6.2%. Government in collaboration with other stakeholders is scaling up antiretroviral therapy in this resource limited, post-conflict setting through the decentralized health care delivery system. Factors that could influence long-term retention in such a setting are as yet poorly understood. Methodology This was a methodological retrospective review of 402 patient clinic cards, ART register and pharmacy records at regional referral hospital, district hospital and health centre IV. A quantitative approach was used to determine the retention rates for clients initiated on antiretroviral therapy at the three levels of care after 3, 6, 12, and 24 months. Predictors for loss to follow-up were derived from demographic and clinical characteristics captured in the clinic records. ����Data management Data was summarized using frequency tables and bar graphs. Analysis was done using EPI-INFO and SPSS computer packages. Bivariate analysis was carried out to evaluate the association between the variables and loss to follow-up. ����ResultsOverall 43.5% of patients were lost to follow-up from the ART programs. The district hospital retained most patients (73.1%), the regional referral hospital (53.7%) and health centre IV retained least (36.6%). Majority of patients were lost to follow-up after 3 completed months and least after 24 completed months. Patients accessing ART at the district hospital were five times more likely to remain in care (OR 0.21 95% CI 0.08, 0.50) and those at the regional hospital 2 times more likely (OR 0.48 95% CI 0.22, 1.07) as compared to those at the health centre. Loss to follow-up was 16 times more likely to occur in the bedridden functional status (OR16.3 95% CI2.0, 132.2) and three times more likely in the ambulant patient compared to those able to work. In this study age, sex, occupation, weight, WHO clinical stage and CD4 lymphocyte count were not predictive of retention on the ART program. ����ConclusionProviding an accessible high quality ART service is feasible in the post-conflict region, as illustrated by the level of retention of patients at Kitgum District Hospital, through task shifting, training, and mentoring of lower cadre health workers. The collaboration of community based organizations to enhance the continuum of care at community level significantly improves retention of patient in the programme. There is need to relax the eligibility criteria and adopt strategies that will promote earlier access to VCT services so that appropriate care is initiated to patients before they are too weak.