A Participatory Approach to Improving Retention in HIV Treatment and Care for Newly Diagnosed Patients in a Secondary Health Facility in Sierra Leone

Abstract

The bottom line for any successful HIV program is adherence to therapy and retention in care with the subsequent benefit of achieving undetectable viral levels. Research has shown that poor retention in care for HIV infection has a negative impact on survival and health outcomes. This study aimed to improve retention in care at a secondary health in Freetown, Sierra Leone through a participatory approach that involved health workers and support groups. Our interventions included implementing a participatory needs assessment, reorganising the patient flow, improving communication between health workers and people living with HIV/AIDS (PLHIV), trainings and capacity building and improving the content of support group meetings. The baseline period was from June 2012 to June 2013 while the post intervention period was from June 2013 to June 2014. At baseline, a total of 47 patients were newly diagnosed out of which 19 were male and 28 were female. The median age was 32. Twenty were single, 18 married, 7 widowed and one divorced with one confirmed dead. In all, 15 were retained in care while 31 were lost to follow up. Our baseline retention was therefore 33%. Post intervention, a total of 54 patients was newly diagnosed out of which 48 were female and six were male. The median age was 29. Twenty were single, 27 married and 7 widowed. Eleven were confirmed dead and 1 asked to be transferred to a nearby facility due to reasons of distance. Thirty nine were retained in care while three were lost to follow up. Our baseline retention was therefore 93%. The results therefore showed that retention in care improved from 33% to 93% over a 6 month period. We conclude that while there are generic interventions that could be applied at program level to improve retention in care, interventions need to be context specific and fully participatory to cater to the multi-pronged yet unique peculiarities of every setting.

Predictors of retention in the prospective HIV prevention OKAPI cohort in Kinshasa

“…Teague and colleagues carried out a systematic review in 2018 including 143 longitudinal cohort studies to assess the effectiveness of different retention strategies and found that `barrier-reduction´ strategies were associated with higher retention 27 . Related to transportation barriers, reporting a longer distance to the closest center for ARV distribution was inversely associated with retention at 6-month follow-up, as previously reported by other authors 4 , 15 , 25 , 30 , 52 , 57 . As recommended by other researchers 27 , 46 , home visits were offered to improve retention in the cohort.…”

The moderating effect of HIV-stigma on the relationship between sources of perceived social support and self-efficacy among adult patients living with HIV, in KwaZulu-Natal, South Africa.

“…[12] Several studies have shown that adherence to ART can be explained by a myriad of factors. [1] Adherence to ART is a complex challenge, since it a life-long commitment that requires PLWH to achieve an optimal adherence level without fail every day, while having to bear with diverse barriers associated with it [16] for instance social support has been revealed to be a significant predictor of adherence to ART. [2]…”