Retention in HIV Care of Children Living with HIV Aged 0 to 14 Years in Embu County, Kenya
Ikiara, Eliza Kathure
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Globally, children living with HIV aged below 15 years were 1.7 million in 2020, and 90% of these children are in sub-Saharan Africa. In Kenya, the Ministry of Health estimates that 139,000 children were living with HIV in 2018. This constitutes 10% of all the people living with HIV in Kenya. Retention in care refers to the process that begins when a person living with HIV engages in care for the first time, is successfully linked to services, then is assessed for eligibility and is finally initiated on antiretroviral therapy (ART) and retained in lifelong ART care. According to NASCOP, Embu County is performing well in PMTCT interventions, with coverage of maternal ART prophylaxis at 70% in 2017 and infant prophylaxis at 90%. However, the care and treatment of children living with HIV in Embu County is still wanting with the viral suppression among children at only 40%. There is little information on the retention in HIV care of children, especially those aged below 10 years, in Kenya. This study sought to reveal challenges towards retaining children in HIV care in Embu County. This, in turn, provided possible strategies towards directly improving ART coverage among children living with HIV in Embu County by ensuring their retention in care. The main objective of the study was to determine the retention in HIV care of children living with HIV aged 0 to 14 years in Embu County. The study design was a descriptive cross sectional study. The study population was children living with HIV aged 0 to 14 years enrolled in care in Embu County. The data collected was both qualitative and quantitative. Quantitative data was collected by interviewer administered structured questionnaires to the caregivers of the children as well as older children (12 to 14 years). Also there was secondary data collection from the electronic CCC records to determine the proportion of children retained in HIV care. Qualitative data was collected via focus group discussions of caregivers as well as key informant interviews. Both descriptive and inferential statistics were used in data analysis. Data from the structured questionnaire was coded and entered into Epi Info version 7. R software was used for analysis. The study found that the retention rate at 12, 24 and 60 months were 80.4%, 56.6% and 38.5% respectively. The patient factor that was significantly positively associated with retention was older age of the child (aOR=1.13, 95% CI (1.03, 1.24), p=0.009)while the child being very sick was negatively associated (aOR = 0.19, 95% CI (0.07, 0.59), p=0.003).The caregiver/family factors significantly negatively associated with retention were HIV positive sibling (aOR=0.26, 95% CI (0.10, 0.68), p=0.01), stigma (aOR=0.35, 95% CI (0.15, 0.77), p=0.01), work/child care responsibilities (aOR=0.28, 95% CI (0.13, 0.58), p = 0.001) and denial of child’s HIV status (aOR=0.10, 95% CI (0.02, 0.47), 0.003). However, the caregiver being HIV positive was positively associated (aOR = 5.48, 95% CI (2.44, 12.97), p =0.001).The programme factor significantly negatively associated with retention was industrial action (strike) by health workers (aOR=0.18, 95% CI (0.05, 0.75, p=0.01), while scheduling of appointments during school going hours was positively associated (aOR=2.27, 95% CI (1.14, 4.59), p=0.02). The key informant interviews revealed denial of HIV status, lack of disclosure to children, orphaned children, financial barriers and understaffing were important challenges towards retention in care. The focus group discussions cited stigma, lack of disclosure to children, financial barriers, transport challenges and long waiting times as important factors affecting retention. It was concluded from the study that the retention rate at 12 months was high but drastically dropped at 60 months. Patient factors, caregiver/family factors and programme factors were significantly associated with retention in HIV care of children aged 0-14 years in Embu County.