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Patient Attrition Between Diagnosis With HIV in Pregnancy-Related Services and Long-Term HIV Care and Treatment Services in Kenya: A Retrospective Study

Ferguson, Laura MA, MSc, PhD*,†; Lewis, James BA, MSc, PhD*,‡; Grant, Alison D. PhD, FRCP§; Watson-Jones, Deborah MA, BM, BCh, MRCP(UK), MSc, PhD§,‖; Vusha, Sophie BSc; Ong'ech, John O. MBChB, MMed, MPH†,¶; Ross, David A. BA, MSc, BM, BCh, PhD*

JAIDS Journal of Acquired Immune Deficiency Syndromes: July 1st, 2012 - Volume 60 - Issue 3 - p e90–e97
doi: 10.1097/QAI.0b013e318253258a
Implementation and Operational Research: Epidemiology and Prevention

Background: There has been little attention, until recently, to linking women who test HIV positive in pregnancy-related services to long-term HIV care and treatment services.

Methods: A retrospective review of routine hospital data was carried out in 2 hospitals in Kenya. Associations between available demographic information and uptake of HIV-related services within 6 months of HIV diagnosis in pregnancy-related services were assessed using logistic regression. Kaplan–Meier survival analysis was used to assess time between HIV diagnosis and registration at the HIV clinic. Referrals between pregnancy-related and HIV-related services were observed.

Results: At Naivasha hospital, the proportion of women registering at the HIV clinic within 6 months was 17.2% (153 of 892); at Gilgil hospital, it was 35.4% (84 of 237). Highly active antiretroviral therapy (HAART) was initiated by 40% and 27% of known eligible women in Naivasha and Gilgil, respectively. Non-systematic registration of clients on first contact at the HIV clinic, and restricted availability of services due to costs and opening hours were observed. In Naivasha, year, attendance at multiple pregnancy-related visits, and attendance at antenatal care in Naivasha hospital were associated with registration at the HIV clinic. In Gilgil, year, attendance at multiple pregnancy-related visits, and women being in their first pregnancy were associated with the outcome.

Conclusions: Only 4% of women estimated to need HAART for their own care initiated HAART within 6 months of HIV diagnosis. Challenges associated with providing longitudinal care are especially evident in the context of high population mobility. Innovation in service delivery is required to improve uptake of services.

*Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom

University of Nairobi, Institute of Tropical and Infectious Diseases, Nairobi, Kenya

Aurum Institute for Health Research, Johannesburg, South Africa

§Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom

Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania

Department of Obstetrics and Gynaecology, Kenyatta National Hospital, University of Nairobi, Nairobi, Kenya.

Correspondence to: Laura Ferguson, MA, MSc, PhD, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom (e-mail:

Supported by Medical Research Council (United Kingdom)/Economic and Social Research Council (United Kingdom); the UK Department for International Development-supported Evidence for Action on HIV Treatment and Care Systems Research Programme; the Parkes Foundation; and the University of London Central Research Fund.

Presented at International AIDS Conference, July 2010, Vienna, Austria. Abstract no. WEPDE105.

The authors have no conflicts of interest to disclose.

Received September 25, 2011

Accepted February 27, 2012

© 2012 Lippincott Williams & Wilkins, Inc.