Background: With the scale up of HIV treatment programs in resource-limited settings, improving retention in care has become more important. Our study sought to evaluate the impact of clinic remoteness on retention in HIV care.
Methods: A retrospective analysis of data on patients enrolled in a HIV clinic in Haiti from 2005 - 2011 was done. Patients were categorized at various degrees of distance from the clinic site based on addresses provided at registration. Odds ratios and student t-test were calculated to determine which patient characteristics were predictive of retention in HIV care.
Results: Total number of patients enrolled and started on medication was 2253. There were 269 patients 11.9% who had no recorded addresses in the database. Among patients with addresses 1807 (91.1%) were from the local municipality. There was no association between retention in clinic and gender or age. Our analysis revealed significant odds; 1.46 (95% confidence interval, 1.15 - 1.84; P < 0.001) of retention in care for residents of the local municipality compared to all other patients. Residents of the local municipality and its bordering areas were found to be 2.06 (95% confidence interval, 1.71 - 2.47; P < 0.001) times more likely to be retained in care. The odds ratio for being out of care for patients without recorded address was 5.85 (95% confidence interval, 4.14 - 8.28; P < 0.001).
Conclusion: Patients who traveled outside of their home municipality for care were found to be significantly less likely to remain in care. HIV treatment programs must clearly define the communities they care for, and give due attention to individuals who choose to travel beyond their local community clinics for care.
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