Factors Influencing Patients’ Retention in HIV Chronic Care Health Facilities in Nakuru County

Abstract

Human Immunodeficiency Virus /Acquired Immunodeficiency Syndrome (HIV/AIDS) has remained a threat to global public health. WHO says that globally, 39 million people were living with HIV, with 1.3 million newly infected in 2022 and another 40.4 million having succumbed to it since then (World Health Organization [WHO], 2023). Sub-Saharan Africa is home to 54% of HIV-positive people, and Kenya was ranked third in Africa in 2019. Nakuru is one of the four counties in Kenya with the highest number of new infections, with 15% Elimination of Mother-to-Child Transmission (EMTCT) rates in 2022. Antiretroviral Therapy (ART) greatly decreased mortality and morbidity among people living with HIV; however, patients are not kept on care to achieve viral suppression. This study therefore sought to determine the factors influencing patients’ retention in HIV chronic and care health facilities in Nakuru County. The study adopted a descriptive cross-sectional design to investigate the effect of socioeconomic, patient health condition, service delivery, and psychosocial factors on retention in Nakuru County health facilities. The target population was 2,963 people who had been booked for care during the study period. The sample size was 341 based on Morgan’s table. The non-probability method was used to select clients as they arrived for their clinical appointments. For the defaulters, simple random sampling was used, where patients were selected from clinical appointments diaries. Patients at the health facility filled out the questionnaires, while the defaulters with valid phone contacts were interviewed over the phone. Descriptive statistics and binary logistic regression were the main methods of analysis. SPSS version 26 was used to analyse quantitative data. The results established significant relationships between study variables and care retention in Nakuru County facilities. For socioeconomical factors, male patients were 1.2561 times more likely to miss appointments than females, and those living with their sexual partners had a higher chance of missing appointments than singles. Being 40-49 years old or a casual labourer was 0.779 and 0.998 times less likely to miss appointments, respectively. The odds of missing appointments decreased as one's education level increased. For health conditions, the odds of missing an appointment reduce as patients progress to the next stage of HIV-related illness. For service delivery factors, patients were 2.452 times more likely to miss appointments in facilities where health workers were unfriendly; chances of missing appointments increased as time taken in and out of the facility increased; and those with difficulties getting off days to seek medical care were 1.111 times more likely to miss appointments. For psychological reasons, those who never disclosed their HIV status were 1.787 times more likely to miss appointments compared to those who disclosed their status. The study recommends that HIV prevention and care programs should take a multifaceted approach. The concentration should be on service providers' attitudes towards PLHIV, service accessibility, and quality in chronic care facilities. County governments should ensure full implementation of policies prohibiting stigmatisation of HIV patients seeking care in health facilities. Future research should consider targeting other tiers and counties.