Revista de SIDA e investigación clínica

Factors Associated with Attrition from HIV Care during the First Year after Antiretroviral Therapy Initiation in Kenya

Abstract

Mia Liisa van der Kop, Anna Mia Ekstrom, Opondo Awiti-Ujiji, Michael H Chung, Daljeet Mahal, Lehana Thabane, Lawrence Gelmon, Joshua Kimani and Richard Todd Lester

Objectives: A secondary analysis of clinical trial data was used to: (1) estimate retention one year after antiretroviral therapy (ART) initiation; (2) determine factors associated with attrition; and (3) investigate whether participants deemed lost to follow-up (LTFU) were still engaged with the clinic through an interactive mobile phone intervention. Methods: Between 2007 and 2008, adults initiating ART were recruited from three clinics in Kenya. Telephone and community tracing were undertaken to track participants who did not attend their 12-month appointment. Logistic regression was used to determine the association between an interactive text-messaging intervention, purposively selected clinical and socio-demographic factors, and attrition. Data on participant engagement with the text-messaging intervention were extracted from a communications log. Results: Data from 538 participants were included. Retention in care at 6-months was 86.2% (461/535), decreasing to 81.8% (431/527) at 12-months. At 12-months, 53% (51/96) of attrition was due to death and 47% (45/96) to LTFU. A baseline CD4 count <100 was significantly associated with greater attrition (adjusted odds ratio [AOR]=1.83, 95%CI: 1.14-2.94). At 12-months, increased travel time to clinic was significantly associated with greater attrition in females (AOR 1.55, 95%CI: 1.12-2.14), but not in males (AOR 0.95, 95%CI: 0.65-1.39). Of 16 intervention arm participants considered LTFU at 6-months, 11 were in contact with the clinic through text-messaging. At 12-months, less than half (7/18) of participants considered LTFU who were enrolled in the service were participating in the intervention. Conclusions: Our results confirm the association between a low baseline CD4 count and attrition, and suggest that travel time to the clinic is an important factor in retaining female patients. They highlight the importance of tracing studies to estimate retention and the opportunity provided by an interactive mobile health intervention to connect with patients considered LTFU.