Analysis of the Losses in the HIV and AIDs Care Continuum: A Cross Sectional Study at the Effia-Nkwanta Regional Hospital, Western Region

Abstract

Background: In 2017, about 37 million people were living with the HIV infection globally. Anti-retroviral therapy (ART) has proven to improve the clinical outcomes of People Living with HIV/AIDS (PLHIV) by suppressing viral replication. Identifying PLHIV in the population, linking and retaining them in care to ensure viral suppression are stages in the HIV/AIDS Care Continuum (HACC). An analysis of the care continuum usually reveals fall outs of PLHIV from one stage to the other. The aim of this study was to analyze the losses in the care continuum at the ART center of the Effia-Nkwanta Regional Hospital and to assess factors contributing to the losses. Method: Patient records covering the period January to December 2017 on HIV services at the hospital were reviewed. Folders of PLHIV diagnosed at the hospital were reviewed and data on socio-demographic and clinical information extracted onto a data extraction form. Data analysis was done using STATA v15. Pearson Chi- square was used to determine factors associated with the losses at a significance of p<0.05. Logistic regression was used to determine the strength of association. Results: In 2017, at Effia-Nkwanta Regional Hospital, 33.1% (365/1,104) of PLHIV were diagnosed, 88.8% (324/365) linked to care, 84.3% (273/324) initiated on ARVs, 67.8% (185/273) retained in care with 88.5% (85/96) of them attaining viral suppression after a year on ARVs. Three hundred and twenty-four patient folders were reviewed. The median age of the patients was 37 years (IQR: 28-46) with 65.7% (213/324) being females. Viral load results at 12 months was available for 96 out of 198 eligible clients. Overall, proportion of lost to follow-up was 40.1%. Young age (15-24 years), having no comorbidities, inadequate staff and referral system contributed to lost to follow-up. Conclusion: In 2017, diagnosis and retention stages of the HACC were the most affected, however, more diagnosed PLHIV were linked to HIV care. Being young, having no comorbidities, inadequate staff and referral system contributed to the losses in the HACC. In order to reduce the proportion lost to follow-up, strengthening of health information system to track PLHIV who miss appointments, active monitoring of younger clients and those without comorbidities, and development of a system to track clients due for viral load test were recommended