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Continuity of Care is Associated with Higher Appointment Adherence Among HIV Patients in Low Clinician-to-Patient Ratio Facilities in Western Kenya

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Abstract

We sought to determine the relationship between continuity of care and adherence to clinic appointments among patients receiving HIV care in high vs. low clinician-to-patient (C:P) ratios facilities in western Kenya. This retrospective analysis included 12,751 patients receiving HIV care from the Academic Model Providing Access to Healthcare (AMPATH) program, between February 2016–2019. We used logistic regression analysis with generalized estimating equations to estimate the relationship between continuity of care (two consecutive visits with the same provider) and adherence to clinic appointments (within 7 days of a scheduled appointment) over time. Adjusting for covariates, patients in low C:P ratio facilities who had continuity of care, were more likely to be adherent to their appointments compared to those without continuity (adjusted odds ratio = 1.50; 95% confidence interval, 1.33–1.69). Continuity in HIV care may be a factor in clinical adherence among patients in low C:P ratio facilities and should therefore be promoted.

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Availability of Data and Materials

The datasets generated and/or analysed during the current study are not publicly available due to the fact that it contains patient and provider information but are available from the corresponding author on reasonable request.

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Acknowledgements

We would first like to acknowledge all the HIV patients receiving care at AMPATH. We also want to thank all the health providers as well as the AMPATH management team for their dedication in providing treatment and care to all their patients.

Funding

This research was supported by the National Institute of Health (K43TW010684). Our research was further supported in part by a grant to the USAID-AMPATH Partnership from the United States Agency for International Development as part of the President’s Emergency Plan for AIDS Relief (PEPFAR). The USAIDAMPATH Partnership is grateful for the support of the United States Agency for International Development (USAID). The contents of this study are the sole responsibility of AMPATH and do not necessarily reflect the views of USAID, NIH-Forgarty, or the United States Government. Dr. Wilson is partially supported by the Providence/Boston Center for AIDS Research (P30AI042853) and by Institutional Development Award Number U54GM115677 from the National Institute of General Medical Sciences of the National Institutes of Health, which funds Advance Clinical and Translational Research (Advance-CTR) from the Rhode Island IDeA-CTR award (U54GM115677).

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Authors and Affiliations

  1. Department of Mental Health & Behavioral Sciences, School of Medicine, College of Health Sciences, Moi University Eldoret, P.O Box 4604-30100, Eldoret, Kenya

    Juddy Wachira

  2. Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA

    Becky Genberg

  3. Academic Model Providing Access to Healthcare, Eldoret, Kenya

    Anthony Ngeresa, Sylvester Kimayo & Jonathan Dick

  4. Department of Health Services, Policy & Practice, School of Public Health, Brown University, Providence, RI, USA

    Omar Galárraga & Ira Wilson

  5. Department of Medicine, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya

    Sylvester Kimayo

  6. Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada

    Paula Braitstein

  7. Department of Biostatistics, School of Public Health, Brown University, Providence, RI, USA

    Joseph Hogan

  8. Department of Media Studies, School of Literature, Language and Media, University of Witwatersrand, Johannesburg, South Africa

    Juddy Wachira

  9. Department of Maths, Physics and Computing, School of Science and Aerospace Studies, Moi University, Eldoret, Kenya

    Ann Mwangi

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  1. Juddy Wachira
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  10. Joseph Hogan
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Contributions

All authors were aided in the conceptualization of the manuscript. WJ developed the initial drafts. Data analysis was led by HJ, MA, GB, NA and WJ. WI, HJ, GB, MA, GO and WJ reviewed and edited the manuscript for publication. All authors reviewed the final drafts and approved the manuscript for submission.

Corresponding author

Correspondence to Juddy Wachira.

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Competing interests

All authors declare that they have no competing interests.

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All participants provided written consent to participate in the study.

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Not Applicable.

Ethical Approval

Our protocol was reviewed and approved by Moi Teaching and Referral Hospital Institutional Research and Ethics Committee Eldoret Kenya (Approval #0003297). All participants provided written consent to participate in the study.

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Wachira, J., Mwangi, A., Genberg, B. et al. Continuity of Care is Associated with Higher Appointment Adherence Among HIV Patients in Low Clinician-to-Patient Ratio Facilities in Western Kenya. AIDS Behav 26, 3516–3523 (2022). https://doi.org/10.1007/s10461-022-03686-6

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