Retention in care and associated factors among elderly initiated on art at Mulago ISS clinic, Kampala

Abstract

Introduction: Retention on ART is essential for sustained viral suppression and reduced mortality among the elderly (≥60 years) initiated on ART. Elderly retention on ART is affected by sociodemographic, clinical, and facility factors in addition to age associated chronic conditions and decreased immune recovery. Limited information exists on retention in care among elderly initiated on ART in Uganda. This study aimed to document retention in care and associated factors among elderly living with HIV using routine data at Mulago ISS clinic Uganda. Methods: This was a retrospective cohort study on all 280 elderly (≥60 years) participants who initiated ART between 2005 and 2018 at Mulago ISS clinic. Secondary data was collected from patient charts using pretested data abstraction forms. Analysis of factors associated with retention in care was done using multilevel mixed effects Poisson regression model with robust standard errors in Stata version 14. Retention in care was calculated at 3 months, 6 months and 12 months as having 1, 2 and 3 completed visits respectively. Results: Out of 280, 148 (52.9%) were males, median age was 64 (min 60, max104) and WHO HIV stage III were 76 (27.1%). Retention in care was 92.5% (95% CI: 88.7-95.1) at 3 months, 82.1% (95% CI: 77.2-86.2) at 6 months and 72.9% (95% CI: 67.3-77.8) at 12 months. Retention was associated with; marital statuses- married (aIRR 0.77, P <0.04), never married (aIRR 1.73, P 0.05); Education level- primary (aIRR 0.54, P <0.01), secondary (aIRR 0.65, P 0.03), Tertiary (aIRR 0.59, P <0.01); WHO HIV disease- staging II (aIRR 0.68, P <0.01), stage III (aIRR 0.73, P 0.01), Disclosure of status (aIRR 0.12, P <0.01); and Period of ART start- Before2006 (aIRR 21.3, P <0.01). Of the 38 participants that were LTFU at the clinic, 26.3% were retained with other health care providers.

Conclusion: Retention in care was below the 85% WHO minimum set target. May be sensitization of the elderly about HIV testing and importance of early engagement in care by health care providers and ministry of health will improve retention in care. Key words: ART, Retention, Elderly.