Attrition and it’s associated factors among clients not on antretroviral treatment registered in care and treatment centres in Morogoro region

Abstract

Pre ART attrition and its associated factors among Pre ART clients registered in care and Treatment centres in Morogoro Background Despite significant success in scaling up care and treatment programmes in Tanzania, still the majority of people living with HIV (PLHIV) do not access HIV care and treatment. Successfully enrolled PLHIV in care and treatment are lost at every step along the continuum of care, particularly in the period between HIV diagnosis and initiation of ART. This study aims at determining factors associated with attrition among Pre Art adults in HIV/AIDS care and treatment centres (CTC) Methods We conducted a clinic based retrospective cohort study that involves review of data from Pre ART adult clients (≥ 15years) register and client treatment card number 2 (CTC 2 card) at three CTCs in Morogoro from July, 2010 to July 2011. Client baseline characteristics and clinic attendance status at three months interval for a period of 1 year were abstracted using semi structured questionnaire. Pre ART clients who were not in care at their original sites at 1 year of follow up were traced through home based care volunteers and phone calls. Correlates of loss to care were evaluated using logistic regression analysis. Epi info statistical software was used for analysis. Results A total of 369 clients were enrolled in CTC in July 2010 of whom 351 were enrolled in the study. Majority 190(54.1%) of study participants were not ART eligible at enrolment to CTC and only 92(57.1%) of the161 (45.9%) ART eligible clients were initiated on ART. Only 67(28.7%) of the 234 Pre ART clients were still in care at 1 year of follow up. Overall Pre ART attrition from mortality, opted out of care clients and lost to follow up was 87 (37.2%). Controlling for age and sex referral to CTC by health care provider (AOR = 2.5, 95%CI: 1.26 – 5.02) and self stigma (AOR = 5.9, 95%CI; 2.82 – 12.7] were independent risk factors for Pre ART attrition while Client CD4 count check as scheduled v on last visit was protective against Pre ART attrition. Other factors were not statistically significant in multivariate analysis. Conclusion Attrition due to mortality and opt out of care is high among CTC enrolled clients. Majority of death were among ART eligible clients who were not initiated treatment. Self stigma and patients referred to CTC by health care providers were risk for attrition among Pre ART adults enrolled at participated CTCs. Strengthening of CD4 count check to monitor clients as they become eligible for ART as well as prioritizing ART initiation for those clients who are ART eligible in order to minimise Pre ART attrition from mortality and drop out is recommended. Also improvement in linkage between CTC to reduce silent transfers and counselling to PLHIV to disclose their HIV status as this will reduce self stigma is also recommended.