Patient attrition between diagnosis with HIV in pregnancy-related services and long-term HIV care and treatment services in Kenya: A retrospective study.


Ferguson, L; Lewis, J; Grant, AD; Watson-Jones, D; Vusha, S; Ong'ech, JO; Ross, DA; (2012) Patient attrition between diagnosis with HIV in pregnancy-related services and long-term HIV care and treatment services in Kenya: A retrospective study. Journal of acquired immune deficiency syndromes (1999), 60 (3). e90-7. ISSN 1525-4135 DOI: https://doi.org/10.1097/QAI.0b013e318253258a

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Abstract

BACKGROUND: There has been little attention, until recently, to linking women who test HIV positive in pregnancy-related services to long-term HIV care and treatment services.<br/> METHODS: A retrospective review of routine hospital data was carried out in 2 hospitals in Kenya. Associations between available demographic information and uptake of HIV-related services within 6 months of HIV diagnosis in pregnancy-related services were assessed using logistic regression. Kaplan-Meier survival analysis was used to assess time between HIV diagnosis and registration at the HIV clinic. Referrals between pregnancy-related and HIV-related services were observed.<br/> RESULTS: At Naivasha hospital, the proportion of women registering at the HIV clinic within 6 months was 17.2% (153 of 892); at Gilgil hospital, it was 35.4% (84 of 237). Highly active antiretroviral therapy (HAART) was initiated by 40% and 27% of known eligible women in Naivasha and Gilgil, respectively. Non-systematic registration of clients on first contact at the HIV clinic, and restricted availability of services due to costs and opening hours were observed. In Naivasha, year, attendance at multiple pregnancy-related visits, and attendance at antenatal care in Naivasha hospital were associated with registration at the HIV clinic. In Gilgil, year, attendance at multiple pregnancy-related visits, and women being in their first pregnancy were associated with the outcome.<br/> CONCLUSIONS: Only 4% of women estimated to need HAART for their own care initiated HAART within 6 months of HIV diagnosis. Challenges associated with providing longitudinal care are especially evident in the context of high population mobility. Innovation in service delivery is required to improve uptake of services.<br/>

Item Type: Article
Faculty and Department: Faculty of Epidemiology and Population Health > Dept of Infectious Disease Epidemiology
Faculty of Infectious and Tropical Diseases > Dept of Clinical Research
Research Centre: Centre for Evaluation
Tropical Epidemiology Group
Centre for Maternal, Reproductive and Child Health (MARCH)
PubMed ID: 22421747
Web of Science ID: 305804400003
URI: http://researchonline.lshtm.ac.uk/id/eprint/20897

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