Retention trends of adolescents enrolled in care in public health facilities of Kampala capital city.

Abstract

HIV still poses a challenge as the leading cause of death among adolescents in Sub Saharan Africa despite availability of antiretroviral therapy (ART). The high rates of mortality are partly due to suboptimal retention of adolescents in HIV care. With ART scale up services, there is need to keep track of retention of adolescents in HIV care. The Objectives of this study were to determine the retention trends among HIV positive adolescents enrolled in KCCA public health facilities associated factors and experiences of adolescents in HIV care. The Methods: used in this study were; mixed methods design using both quantitative and qualitative data was used for the study. Quantitative data were based on 2095 individual records obtained from the health management information systems (HMIS) registers of six KCCA public health facilitates for the period 2013-2017. A retrospective cohort design was used to determine trends in retention and associated factors. In-depth interviews and focus group discussions were used to determine experiences adolescents in HIV care. Descriptive statistics were used to describe proportions retained in care at 6, 12, 24, 36 and 48 months. Modified Poisson regression with robust variance estimation was used to estimate relative risks and 95% confidence intervals for the association between retention and various factors. The Results in this study indicated that the overall retention was 84.7%, 76.6%, 55%, 34.6%, 17.2 % at 6, 12, 24, 36 and 48 months respectively. The adolescents enrolled in the years of 2015 (RR 0.48, 95% CI 0.4, 0.57), 2016 (RR 0.49, 95% CI 0.42, 0.57) and 2017(RR 0.73, 95% CI 0.61, 0.88) were less likely to be retained compared to 2013. Qualitative findings showed that peer support, decentralized clinics, clinic days’, family support disclosure and patient tracking were positive experiences in care. While negative experiences included poor health worker’s attitude, frequent appointments, conflicting school schedules, drug stock out and lack of family support, which was seen mainly with adolescents that had once been not retained. This study concluded that retention in care is poor the longer the duration in care and special attention should be given for those in care for more than a year. The study recommends that there is need to establish social support groups, long term follow up mechanisms and emphasis on unique qualities of each facility in order to improve retention.