Abstract #107  -  Retention of ART patients at Lodwar District Hospital Comprehensive Care Clinic (CCC), Kenya
Authors:   Presenting Author:   Dr Stanley Bii - NASCOP
Additional Authors:
Aim: To examine the ability to retain patients on ART within the comprehensive care clinic at Lodwar District Hospital.
Method / Issue: The Rift valley province of Kenya has an estimated HIV prevalence of 7% against the national average of 7.4%. Turkana district has an HIV prevalence of 9% which is higher than the national average. The district is arid to desert covering 70,000km2 with a population of 500,000. It is occupied by the Turkana people which is a nomadic pastoralist community. Currently, about 240,000 Kenyans are on ART treatment which is about 60% of those who require treatment.
Results / Comments: The ART clinic within Lodwar district hospital in Turkana district was established in December 2005. Since its inception, it has enrolled 1190 patients under care of which 48 are children while 1142 are adults. The numbers of patients who have ever been started on ARVS are 775 of which 746 are adults while only 29 are children. Currently there are 614 patients on ARVs. Among these are 21 children while 593 are adults. Between January and December 2008, 266 patients were initiated on ART. Out of these, 84 (31.6%) patients have either defaulted or lost to follow-up while 14 (5.3%) patients have since died and 8 have been transferred out. It is possible that most of those who were lost to follow-up could have died.
Discussion: Among patients dropping out of the CCC clinic at Lodwar district hospital, 36.8% of them drop out within one year of being started on ARVs. 5.3% of them die while 31.6% default or are lost to follow-up. Most of those who default are defaulting within the first 3 months of being initiated on ARVs (68%). The reasons which may be attributed to high defaulter rates within Lodwar district hospital include the nomadic nature of the population and therefore they have to move from one place to another in search of water and pasture. The vast distances patients have to travel to reach the hospital may also contribute to high defaulter rates. This is confounded by lack of roads and means of transport and poor mobile phone network coverage. Turkana is also a very poor district with high illiteracy rates and poor health seeking behaviors by the people. Patients therefore usually come to the hospital when they are very sick and disappear when they improve. It is also a food deficit district and most people have to depend on relief food. Traditional medicine may also have a role to play since most people resort to herbal medicine and witchdoctors for their ailments. Lack of proper adherence counseling may also be contributing to the high defaulter rates considering that most default early in treatment. Recommendations: All patients accessing services at the CCC should be taken through proper adherence counseling for them to understand that it is a lifelong treatment. Owing to the nomadic nature of the population and the vast distances involved, mobile clinics would be ideal to take services closer to the people. Nutritional support should be offered at the ART clinic not only to address malnutrition but also as an incentive to the patients to encourage them to attend the clinics.
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