Temporary disengagement and re-engagement in human immunodeficiency virus care in a rural county serving pastoralist communities in Kenya: a retrospective cohort study

Paul Yonga, Stephen Kalya, Lutgarde Lynen, Tom Decroo

Research output: Contribution to journalA1: Web of Science-article

Abstract

Background: Pastoralist communities are known to be hard to reach. The magnitude of temporary disengagement from human immunodeficiency virus (HIV) care is understudied.

Methods: We conducted a retrospective cohort study of temporary disengagement (2 weeks late for a next appointment), virologic response, lost to follow-up (6 months late) and re-engagement in care among patients who started antiretroviral therapy between 2014 and 2016 in Baringo County, Kenya. Predictors of re-engagement after disengagement were estimated using logistic regression.

Results: Of 342 patients, 76.9% disengaged at least once (range 0-7). Of 218 patients with a viral load (VL), 78.0% had a suppressed VL. Those with a history of temporary disengagement from care were less likely to suppress their VL (p=0.002). Six patients had treatment failure (two consecutive VLs >1000 copies/mm3) and all had disengaged at least once. After disengagement from care, male patients (adjusted odds ratio [aOR] 0.3 [95% confidence interval {CI} 0.2 to 0.6]; p

Conclusions: Temporary disengagement was frequent in this pastoralist setting. This indicator is often overlooked, as most studies only report binary outcomes, such as retention in care. Innovative strategies are required to achieve HIV control in rural settings like this pastoralist setting.

Original languageEnglish
JournalInternational Health
Volume12
Issue number2
Pages (from-to)95-100
Number of pages6
ISSN1876-3413
DOIs
Publication statusPublished - 2020

Keywords

  • Adult
  • Anti-Retroviral Agents/therapeutic use
  • Female
  • HIV Infections/drug therapy
  • Humans
  • Kenya
  • Male
  • Middle Aged
  • Retrospective Studies
  • Rural Population
  • Treatment Adherence and Compliance/statistics & numerical data
  • Treatment Outcome
  • Viral Load

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