Challenges for Scaling up ART in a Resource-Limited Setting: A Retrospective Study in Kibera, Kenya

Abstract

Despite free drugs and low associated costs, dropout probabilities in this study are higher and adherence to ART is lower compared with other studies from sub-Saharan Africa. Our results illustrate that ART programs in resource-limited settings, such as Kibera, risk low adherence and retention rates when expanding services. Specific and intensified patient support is needed to minimize the risk of dropout and nonadherence causing future significant health threats not only to individuals but also to public health.

Factors Associated with Attrition from HIV Care during the First Year after Antiretroviral Therapy Initiation in Kenya

“…The review included several estimates of retention in care from HIV programmes in Kenya, many of which were based on studies that were not specifically intended to quantify retention in care [5]. Estimates from studies specially designed to evaluate patient retention were retrospective chart reviews [6,7]. These studies were limited in that they were unable to determine the true status of those considered lost to follow-up (LTFU), potentially underestimating patient retention in care.…”

The influence of traditional medicine and religion on discontinuation of ART in an urban informal settlement in Nairobi, Kenya

“…One previous study from an informal settlement in Kenya, found that 29% of the patients discontinued ART (Unge, et al, 2009). …”

Implementation and outcomes of an active defaulter tracing system for HIV, prevention of mother to child transmission of HIV (PMTCT), and TB patients in Kibera, Nairobi, Kenya

“…6 A 2009 study in Kibera, an urban slum in Nairobi, found that 29% of patients started on ART dropped out of the programme at least once for 90 days or more, and the probability of remaining in the programme at two years was only 65%. 7 Patient retention has also been difficult for prevention of mother to child transmission of HIV (PMTCT) programmes. [8][9][10][11] There is even less literature on the true outcomes of TB defaulters.…”

“…4,5,[13][14][15][16][17][18][19][20][21] Modes of patient tracing briefly described in other studies include telephone calls, letters, outreach teams and home visits. 4,7,14,16,17,22 Classifying all patients whose vital status (e.g. death, transfer out) is unknown as LTFU contributes to inaccurate conclusions about the effectiveness of a given programme.…”