Factors associated with clinic non-attendance among HIV infected adolescents at the Mildmay Centre in Wakiso District Uganda.
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Health seeking behaviour among adolescents is poor yet they face many health challenges including unwanted pregnancies, sexually infected infections (STI) and HIV infection. The Mildmay Centre currently provides care to about 2,520 HIV positive children (below 18 years), however, 10% of the adolescents do not attend their regular monthly schedule clinic visits. OBJECTIVE: To determine factors associated with clinic non-attendance among HIV infected adolescents receiving care in mild may centre so as to design appropriate interventions to address to address the problem of clinic non-attendance by the adolescent clients. METHODS: An unmatched case control study was conducted where cases were adolescents who missed 2 or more scheduled visits in the past 12 months, and controls were those who missed one or none of the scheduled visits in the same period. A total of 238 adolescents were interviewed using a semi-structured interviewer administered questionnaire. Pearson chi-square test of significance was used to assess the association between categorical variables and logistic regression model to obtain odds ratios (ORs) and their 95% confidence intervals (CI) as a measure of association between clinic non-attendance and factors such as sex, distance from care facilities, presence of caretaker, HIV disclosure and satisfaction with health professionals, while controlling for confounding factors. RESULTS: A total of 115 cases and 123 controls were selected for this study. After adjusting for confounders. Factors associated with increased odds of clinic of non-attendance were being of male gender (adj. OR=2.3; 95% CI (2.00, 2.56)),living beyond 20 km from care facility (adj. 0R 2.5; 95% CI (2.19, 2.91)), absence of caretakers (adj OR=2.2 95% CI (1.96,2.53)), Dissatisfaction with counsellors whom they talk to/or who attend to them (adj. OR=2.1; 95% CI (1.83, 2.43)), Dissatisfaction with easy and quick access to health professionals apart from doctors (adj. OR=2.2, 95% CI(1.90, 2.54), Dissatisfaction counselling techniques (adj. OR=2.0, 95% CI (1.63, 2.27)). Rating quality of health as poor was significantly associated with reduced odds of non attendance (adj. OR=0.5; 95%CI (0.14, 0.86)). CONCLUSION: Dissatisfaction with health workers, distance from home to care facility and lack of a caretaker are key factors in determining non-attendance in this population of adolescent. RECOMMENDATIONS: The Mildmay Centre should ensure that health professionals caring for adolescents improve on their client-provider attitude so as to improve clinic attendance. Health workers need to get sensitized on adolescent’s behaviour and sexuality so that they can understand and accommodate adolescents. The mild may centre needs to take health care services nearer to the adolescents. More sensitization needs to be given to care givers about anti-retroviral drugs, importance of adherence and clinic attendance to ensure that they give all the support to these adolescents to improve clinic attendance.