Predictors of Retention in Care among Human Immunodeficiency Virus Infected Pregnant Women in Narok County, Kenya
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Retention is critical to HIV-infected women for the prevention of mother to child infection, reduction of maternal morbidity and mortality. Treatment drop out is a major challenge that hinders the success of elimination of mother to child transmission (EMTCT) of HIV in Kenya and Sub Saharan Africa. Although all pregnant human immunodeficiency virus (HIV) infected women in Kenya are initiated on lifelong antiretroviral treatment (ART) irrespective of CD4 count or WHO staging, not all patients who are initiated on antiretroviral treatment are retained in care. The retention in care in Narok County is far below the national retention. Despite measures and efforts by several stakeholders in HIV prevention, care and treatment to increase retention in care among HIV infected pregnant women retention is still very low. As a result, the risk of maternal-to-child transmission in Narok County is still high. Moreover, there is limited data on predictors of retention in care among women in Kenya. The main objective of this study was to determine the predictors of retention in care among HIV infected pregnant women in Narok sub-county hospitals, Kenya. The specific objectives were; to establish demographic and socioeconomic factors that influence retention in care among HIV infected pregnant women in Narok sub-county hospitals, to determine the knowledge, attitude and perception of EMTCT among HIV infected pregnant women in Narok sub-county hospitals, to determine the medication-related factors among HIV infected pregnant women in Narok sub-county hospitals and to establish the health system-related factors that influence retention in care among HIV infected pregnant women in Narok sub-county hospitals. The study adopted a cross-sectional mixed method design. Purposive sampling method was used to sample the required sample size of 117 HIV infected pregnant women, the participants of the Focus Group Discussions (FGD) and Key Informant Interviews (KII). The study was conducted in all Narok sub-county hospitals. Questionnaire was used to collect quantitative data. Focus group discussion and KII guides were used to collect qualitative data. Quantitative and qualitative data was analyzed using SPSS version 21 and Nvivo version 14 respectively. Chi square test and logistic regression analysis were used to determine the predictors of retention in HIV care. Thematic content analysis was done for qualitative data. The mean age of participants was 30 years (SD=6.48). Among the demographic and socio economic factors education, marital status, religion, distance to health facility and partner knowledge were significantly associated with retention in care with a p-value of 0.031, 0.040, 0.023, 0.024 and 0.03 respectively. Eighty three percent of the women had high knowledge on cause of HIV, 43% on mode of HIV transmission and 34% on when maternal to child transmission of HIV occurs. It was also found that majority of HIV infected pregnant women had positive attitude and good perception towards EMTCT services offered in the hospitals. On medication-related factors, ARVs side effects (P<0.041) and being on combined treatment drug (P<0.035) were that were found to be associated with retention in care. This study also established that health system-related factors influenced retention in care among HIV infected pregnant women. However, only ARV availability had a significant association with retention in care (P<0.001, OR=0.19). The multiple logistic regression was used to predict the influence of grouped variables. Overall, the model was a significant predictor of retention in care. Of the grouped predictors, demographic and socio-economic (P<0.03, OR=0.71) and knowledge, attitude and perception of EMTCT (P<0.01, OR=1.77) were found to be predictors of retention. Medication related factors (P<0.18, OR=12.84) and health system related factors (P<0.34, OR=5.14) were found not to be significant predictors of retention in care. The study recommends that the Ministry of Health and other stakeholders should hold community awareness and sensitization programmes on benefits of prevention of mother to child transmission of HIV services to increase retention in care in order to prevent vertical and horizontal transmission of HIV.