Community outreach programs and major adherence lapses with antiretroviral therapy in rural Kakamega, Kenya

ABSTRACT

We investigated features of major adherence lapses in antiretroviral therapy (ART) at public Emusanda Health Centre in rural Kakamega County, Kenya using medical records from 2008 to 2015 for all 306 eligible patients receiving ART. Data were modelled using survival analysis. Patients were more likely to lapse if they received stavudine (hazard ratio (HR) 2.54, 95% confidence interval (95%CI):1.44–4.47) or zidovudine (HR 1.64, 95%CI:1.02–2.63) relative to tenofovir. Each day a patient slept hungry per month increased risk of major adherence lapse by 3% (95%CI:0–7%). Isolated home visits by community health workers (CHWs) were more effective to assist patients to return to the health centre than isolated phone calls (HR 2.52, 95%CI:1.02–6.20).

KEYWORDS:

• Adherence
• food insecurity
• tenofovir
• support groups
• community health workers
• home visits

Acknowledgements

We thank CHWs Mildred Alibitsa, Sophia Amakove, Getreil Andayi, Odelia Arumba, Dorcas Bulima, Winfred Chengo, Josphine Eruata, Leonida Imbosa, Chrisandos Odinga, and Beatrice Shikami; Elders Chair Josphat Sakwa; Emusanda Chair Stanley Ingoka; Dr. James Ouda; Prof. Elizabeth Abenga; Prof. Eran Bendavid; and Prof. Lars Osterberg for their contributions.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This research was supported by Stanford Medical Scholars Fellowship [grant number 11571].