Determinants of adherence to antiretroviral therapy and retention of patients attending comprehensive care clinic at Karatina Sub-County Hospital Nyeri County Kenya

Abstract

Objectives: To establish determinants of antiretroviral therapy (ART) adherence and rate of retention over a period of one year among Human Immuno- deficiency virus (HIV) patients (PLHIV) at Karatina Sub-County Hospital (KSCH). To compare adherence and retention according to socio-demographic  factors. To establish a relationship between non-adherence and loss to follow-up (LTFU) and poor patient outcomes.

Methods: Cross-sectional study  design was used, and the study population was HIV patients at KSCH. Data was collected among 119 participants using interviewer-administered  questionnaires and retrieval of health data from databases in the comprehensive care clinic (CCC).

Results: Majority (63.9%) of participants were female,  56.6% attained primary education, 48.7% married and 42% adults (46-59 years). Most (59.7%) of HIV cases were recently diagnosed. Highest proportion  (47.1%) of participants was casual workers and the majority (58%) had normal nutrition status. Forty six percent of participants had high ART adherence  while 54% had low adherence. Retention rate has been declining from 87.8% in April-June 2020 to 66% in January-March 2021 and rose to 76.2% in April- June 2021 and then to 78% in October-December 2021. ART adherence among CCC patients in KSCH was 85.7%.

Conclusion: ART adherence among CCC  patients in KSCH is unsatisfactory. Determinants of adherence included: missed appointments, poor knowledge, patient-provider relationship and  concurrent treatment of other illnesses. Most non-adherent patients were in LTFU category due to defaulting, change of caregivers and poor family  support. Poor management of HIV infection was associated with poor patient outcomes. Though not significant, increase in mortality and LTFU coincided  with onset of COVID-19 pandemic in early 2020.