A SOCIO-ECOLOGICAL APPROACH TO BARRIERS AND FACILITATORS OF RETENTION IN HUMAN IMMUNODEFICIENCY VIRUS (HIV) CARE IN ONDO STATE, NIGERIA
Retention in HIV care or the continuous and uninterrupted receipt of comprehensive HIV care and treatment services is a health behaviour essential in reducing AIDS related morbidity/mortality, prolonging survival of persons living with HIV/AIDS (PLHIV) as well as achieving epidemic control by minimizing viral transmission and the incidence of new HIV infections. It is a health promoting behaviour that is of particular importance in countries with the highest HIV disease burden including Nigeria, with over 10% of the global HIV disease burden. Although studies have confirmed that retention ratesare sub-optimal both in developed and developing countries, there is limited information on how retention rates vary with time in Nigeria. This study was therefore conducted to determine the percentage of HIV-infected adults that were continuously retained in HIV care 36 months after starting antiretroviral treatment (ART) as well as identify barriers and facilitators of retention.
This study employed a mixed-method research design and was conducted at State Specialist Hospital, Akure in Ondo state, Nigeria. A total of 420 HIV-infected persons who started antiretroviral treatment between January and December 2013 were purposively selected and retrospectively followed up for a total of 36 months in order to determine retention rates (operationalized using the 4-month hospital visit constancy measure); by 12, 24 and 36 months post-treatment initiation. Additionally, 12 in-depth interviews were conducted with HIV-infected persons receiving treatment at the facility in order to elicit barriers and facilitators of retention in HIV care. The socio-ecological framework of health promotion guided the coding of qualitative research data while grounded and density analysis was used in identifying the most significant barriers and facilitators of retention in HIV care.
In this study, retention rates were observed to decline significantly among both males and females. Retention rates at 12, 24 and 36 months were 57.95%, 50.00% and 40.22% for males and 77.24%, 63.31% and 49.74% for females, respectively. Stigma, poor health literacy and clinic distance/lack of transportation fare were the most important barriers to retention while good health literacy and a positive healthcare worker – client relationship were the most significant facilitators of retention identified by study participants.
In conclusion, the study highlights the need for novel strategies to promote retention especially among men. These strategies include prioritization and allocation of resources by HIV program planners to facilitate implementation of health promotion interventions; the development of a national HIV/AIDS patient education curriculum to promote health literacy; the conduct of regular mass media campaigns to address HIV-related stigma in the community. There is also a need for large-scale studies that better characterizing the barriers of retention particularly the dimensions of HIV-related stigma in Nigeria.
Keywords: Human Immunodeficiency Virus (HIV); Retention in HIV care; Retained in HIV care; Barriers to retention in HIV care; Facilitators of retention in HIV care