Volume 5 • Issue 10 • 1000354 Open Access Research Article J AIDS Clin Res ISSN: 2155-6113 JAR an open access journal van der Kop et al., J AIDS Clin Res 2014, 5:10 http://dx.doi.org/10.4172/2155-6113.1000354 AIDS & Clinical Research Factors Associated with Attrition from HIV Care during the First Year after Antiretroviral Therapy Initiation in Kenya Mia Liisa van der Kop 1,2* , Anna Mia Ekström 1,3 , Opondo Awiti-Ujiji 1, , Michael H Chung 4 , Daljeet Mahal 5 , Lehana Thabane 6 , Lawrence Gelmon 7 , Joshua Kimani 8 and Richard Todd Lester 2 1 Department of Public Health Sciences, Karolinska Institute, Widerströmska Huset, Tomtebodavägen 18A, Stockholm 171-77, Sweden 2 Division of Infectious Diseases, University of British Columbia, 828 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada 3 Department of Infectious Diseases, I73, Karolinska University Hospital, 141 86, Stockholm, Sweden 4 Departments of Global Health, Medicine and Epidemiology, University of Washington, 325 9th Avenue, Seattle, WA 98104, USA 5 British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada 6 Department of Clinical Epidemiology and Biostatistics, McMaster University, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada 7 School Department of Medical Microbiology, University of Manitoba, 745 Bannatyne Avenue, Winnipeg, MB R3E 0J9, Canada 8 Center for STD/HIV Research and Training, University of Nairobi, PO Box 19676-00202, Nairobi, Kenya *Corresponding author: Mia van der Kop, Division of Infectious Diseases, University of British Columbia, 828 West 10th Avenue, Vancouver, BC, V5Z IM9, Canada, Tel: +1 604 875 4111; Fax: +1 604 875 4013; E-mail: miavanderkop@gmail.com Received June 25, 2014; Accepted September 20, 2014; Published September 30, 2014 Citation: van der Kop ML, Ekström AM, Awiti-Ujiji O, Chung MH, Mahal D, et al. (2014) Factors Associated with Attrition from HIV Care during the First Year after Antiretroviral Therapy Initiation in Kenya. J AIDS Clin Res 5: 354. doi:10.4172/2155- 6113.1000354 Copyright: © 2014 van der Kop ML, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Keywords: HIV/AIDS; Antiretroviral therapy; Sub-Saharan Africa; Retention; Attrition; Text messaging; Mobile phones Introduction Background and rationale Retention in care is critical to maximizing patient outcomes and to the success of HIV care and treatment programmes. Retaining patients who are on antiretroviral therapy (ART) minimizes the likelihood of treatment interruptions and discontinuation, which not only reduces patient morbidity and mortality, [1] but also minimizes the risk of drug resistance [2] and viral transmission [3]. Despite these and other beneits, a recent systematic review indicates that only 80% of patients who initiate ART in sub-Saharan Africa remain in care at 12-months [4]. he review included several estimates of retention in care from HIV programmes in Kenya, many of which were based on studies that were not speciically intended to quantify retention in care [5]. Estimates from studies specially designed to evaluate patient retention were retrospective chart reviews [6,7]. hese studies were limited in that they were unable to determine the true status of those considered lost to follow-up (LTFU), potentially underestimating patient retention in care. Reports indicate that when patients’ activity is traced outside of the clinic at which patients initially registered, a signiicant proportion of patients are active in care elsewhere [8]. We investigated patient retention using data from a previously published randomized controlled trial (RCT) in Kenya involving adults initiating ART [9]. Participant tracing enabled us to ascertain the status of those who did not return to the clinic for their 12-month appointment, and helped distinguish between participants ‘retained in clinic’ versus those retained in care. here is conlicting evidence on individual-level factors associated with retention in care, such as age, CD4 count, and travel time to clinic [7,10,11]. In addition to these factors, we investigated whether Abstract 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 signiicantly 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 signiicantly 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 conirm 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.