Determinants of utilization of a no-cost HIV transition clinic: a cross-sectional study of young adults living with HIV/AIDS

Figures & data

Figure 1 Flow diagram showing recruitment of study participants.

Abbreviations: IDI, Infectious Diseases Institute; TC-IDI, Transition Clinic at Infectious Diseases Institute.

Table 1 Demographic and clinical characteristics of YALHA attending the HTC

Characteristic	Category	Frequency (N=379)
Sex	Male	68 (17.9%)
	Female	311 (82.1%)
Age in years (mean =22.5, SD =2.0)	15–19 years	41 (10.8%)
	20–24 years	338 (89.2%)
Highest level of education attained	Primary school or below	142 (37.5%)
	Secondary school	176 (46.4%)
	Tertiary/university level	61 (16.1%)
Religion	Catholic	134 (35.4%)
	Protestant	102 (26.9%)
	Moslem	63 (16.6%)
	Pentecostal	80 (21.1%)
Employment status	Employed	160 (42.2%)
	Unemployed	219 (57.8%)
Location of residence	Urban	245 (64.6%)
	Rural	134 (35.4%)
Marital Status	Married	184 (48.6%)
	Not married	195 (51.4%)
Route through which HIV was acquired	1 do not know	64 (16.9%)
	MTCT	69 (18.2%)
	Sexual intercourse	246 (64.9%)
Ever accessed HIV/AIDs care elsewhere	Yes	72 (19.0%)
	No	307 (81.0%)
Currently on ART (Antiretroviral therapy)	Yes	231 (61.0%)
	No	148 (39.0%)
Last CD4 counts (/μL) (mean =402.3; SD =293.3)	≤250	91 (24.0%)
	≥251	288 (76.0%)
Word Health Organization (WHO) HIV clinical stage	I	93 (24.5%)
	II	132 (34.8%)
	III	90 (23.8%)
	IV	64 (16.9%)

Abbreviations: AIDS, acquired immunodeficiency syndrome; ART, antiretroviral therapy; HIV, human immunodeficiency virus; HTC, HIV transition clinic; MTCT, mother-to-child transmission; SD, standard deviation; YALHA, young adults living with HIV/AIDS.

Figure 2 Graph showing HTC services utilized by YALHA in the 6 months prior to the study.

Abbreviations: AIDS, acquired immunodeficiency syndrome; HIV, human immunodeficiency virus; HTC, HIV transition clinic; YALHA, young adults living with HIV/AIDS.

Table 2 Relationships between YALHA demographic and clinical characteristics with HTC utilization

Characteristic	Category	Frequency (N=379)	Regular utilizers frequency (N=123)	Irregular utilizers frequency (N=256)	X^2	P value	cOR	95% Cl
Sex	Male	68 (17.9%)	22 (17.9%)	46 (18.0%)	0.00	0.984	1.00
	Female	311 (82.1%)	101 (82.1%)	210 (82.0%)			1.01	0.57–1.76
Location of residence	Urban	245 (64.6%)	69 (56.1%)	176 (68.8%)	5.83	0.016*	1.00
	Rural	134 (35.4%)	54 (43.9%)	80 (31.3%)			1.72	1.11–2.68*
Age category in years	15–19	41 (10.8%)	19 (15.4%)	22 (8.6%)	4.04	0.044*	1.00
	20–24	338 (89.2%)	104 (84.6%)	234 (91.4%)			0.51	0.27–0.99*
Highest level of education attained	Primary school	142 (37.5%)	44 (35.8%)	98 (38.3%)	0.27	0.875	1.00
	Secondary school	176 (46.4%)	58 (47.2%)	118 (46.1%)			1.09	0.68–1.76
	Tertiary/university	61 (16.1%)	21 (17.0%)	40 (15.6%)			1.17	0.62–2.21
Religion	Catholic	134 (35.4%)	47 (38.2%)	87 (34.0%)	3.09	0.378	1.00
	Protestant	102 (26.9%)	26 (21.1%)	76 (29.7%)			0.63	0.36–1.12
	Moslem	63 (16.6%)	22 (17.9%)	41 (16.0%)			0.99	0.53–1.86
	Pentecostal	80 (121.1%)	28 (22.8%)	52 (20.3%)			1.00	0.56–1.78
Employment status	Employed	160 (42.2%)	47 (38.2%)	113 (44.1%)	1.20	0.274	1.00
	Unemployed	219 (57.8%)	76 (61.8%)	143 (55.9%)			1.28	0.82–1.98
Marital status	Married	184 (48.6%)	62 (50.4%)	122 (47.7%)	0.25	0.616	1.00
	Not married	195 (51.4%)	61 (49.6%)	134 (52.3%)			0.90	0.58–1.38
Route through which HIV was acquired	I do not know	64 (16.9%)	19 (15.5%)	45 (17.6%)	5.99	0.050*	1.00
	MTCT	69 (18.2%)	31 (25.2%)	38 (14.8%)			1.93	0.94–3.95
	Sexual intercourse	246 (64.9%)	73 (59.3%)	173 (67.6%)			1.00	0.55–1.82
Accessed HIV/AIDS care elsewhere	Yes	72 (19.0%)	28 (22.8%)	44 (17.2%)	1.68	0.195	1.00
	No	307 (81.0%)	95 (77.2%)	212 (82.8%)			0.70	0.41–1.20
Currently on ART	Yes	231 (61.0%)	101 (82.1%)	130 (50.8%)	34.27	0.000***	1 00
	No	148 (39.0%)	22 (17.9%)	126 (49.2%)			0.22	0.13–0.38**
Last CD4 count (/μL)	≤250	91 (24.0%)	45 (36.6%)	46 (18.0%)	15.78	0.000***	1.00
	≥251	288 (76.0%)	78 (63.4%)	210 (82.0%)			0.40	0.25–0.62**
WHO HIV clinical stage	I	93 (24.5%)	23 (18.7%)	70 (27.3%)	7.81	0.050*	1.00
	II	132(34.8%)	38 (30.9%)	94 (36.7%)			1.23	0.67–2.25
	III	90 (23.8%)	35 (28.4%)	55 (21.5%)			1.94	1.03–3.65*
	IV	64 (16.9%)	27 (22.0%)	37 (14.5%)			2.22	1.12–4.40*

Notes:

* P-value ≤0.05

** P-value ≤0.001

*** P-value =0.000.

Abbreviations: 95% CI, 95% confidence interval; AIDS, acquired immunodeficiency syndrome; ART, antiretroviral therapy; cOR, crude odds ratio; HIV, human immunodeficiency virus; HTC, HIV transition clinic; MTCT, mother-to-child transmission; WHO, World Health Organization; YALHA, young adults living with HIV/AIDS; CD4, T-helper cells; (χ²), chi-square; N, number; P-value, level of significance.

Table 3 Community determinants of HTC utilization by YALHA

Community factor and response	Frequency (N=379)	Regular utilizers frequency (N=123)	Irregular utilizers frequency (N=256)	X^2	P value	cOR	95% CI
Has a family member to remind about appointments
Yes	238 (63.0%)	85 (70.0%)	153 (60.0%)			1.00
No	140 (37.0%)	37 (30.0%)	103 (40.0%)	3.48	0.062	0.65	0.41–1.02
Feels rejected because of HIV status
Yes	76 (20.0%)	27 (22.0%)	49 (19.0%)			1.00
No	303 (80.0%)	96 (78.0%)	207 (81.0%)	0.41	0.522	0.84	0.50–1.43
Disclosed HIV status to another person who is not a HPC
Yes	354 (93.4%)	112 (91.1%)	242 (94.5%)			1.00
No	25 (6.6%)	11 (8.9%)	14 (5.5%)	1.63	0.202	1.70	0.75–3.86
Has a regular caregiver at home
Yes	309 (81.5%)	109 (88.6%)	200 (78.1%)			1.00
No	70 (18.5%)	14 (11.4%)	56 (21.9%)	6.07	0.014*	0.46	0.24–0.86*

Note:

* P-value ≤0.05.

Abbreviations: 95% CI, 95% confidence interval; AIDS, acquired immunodeficiency syndrome; cOR, crude odds ratio; HIV, human immunodeficiency virus; HPC, health care provider; HTC, HIV transition clinic; YALHA, young adults living with HIV/AIDS; (χ²), chi-square.

Table 4 Health services delivery factors associated with HTC utilization by YALHA

Health services delivery determinants	Category	Frequency (N=379)	Regular utilizers frequency (N=123)	Irregular utilizers frequency (N=256)	X^2	P value	cOR	95% Cl
Waiting time during clinic appointments (hours)	0–1	139 (36.7%)	36 (29.3%)	103 (40.2%)			1.00
	1–2	135 (35.6%)	47 (38.2%)	88 (34.4%)			1.53	0.91–2.57
	>3	105 (27.7%)	40 (32.5%)	65 (25.4%)	4.59	0.101	1.76	1.02–3.04*
Rating of the general conduct of the clinic staff	Very good	234 (61.7%)	77 (62.6%)	157 (61.3%)			1.00
	Good	145 (38.3%)	46 (37.4%)	99 (38.7%)	0.06	0.81	0.95	0.61–1.48
Feels free to express feelings about clinic	Yes	148 (39%)	44 (36%)	104 (40.6%)			1.00
	No	231 (61%)	79 (64%)	152 (59.4%)	0.82	0.37	1.23	0.79–1.92
Attends health education at the clinic	Yes	198 (52.2%)	69 (56.1%)	129 (50.4%)			1.00
	No	181 (47.8%)	54 (43.9%)	127 (49.6%)	1.08	0.30	0.79	0.52–1.22
Utilized counseling services	Yes	264 (69.7%)	99 (80.5%)	165 (64.5%)			1.00
	No	115 (30.3%)	24 (19.5%)	91 (35.5%)	10.11	0.001**	0.44	0.26–0.74**
Utilized clinical examination services	Yes	364 (96%)	123 (100%)	241 (94.1%)
	No	15 (4%)	0 (0%)	15 (5.9%)	7.50	0.006*	–	–
Utilized peer support services offered by clinic	Yes	75 (19.8%)	29 (23.6%)	46 (18%)			1.00
	No	304 (80.2%)	94 (76.4%)	210 (82%)	1.65	0.199	0.71	0.42–1.20
Utilized laboratory services	Yes	330 (87.1%)	115 (93.5%)	215 (84%)			1.00
	No	49 (12.9%)	8 (6.5%)	41 (16%)	6.68	0.010*	0.36	0.17–0.80**
Utilized home visiting services of the clinic	Yes	22 (5.8%)	5 (4.1%)	17 (6.6%)			1.00
	No	357 (94.2%)	118 (95.9%)	239 (93.4%)	1.01	0.315	1.68	0.60–4.66

Note:

* P-value ≤0.05

** P-value ≤0.001.

Abbreviations: 95% CI, 95% confidence interval; AIDS, acquired immunodeficiency syndrome; cOR, crude odds ratio; HIV, human immunodeficiency virus; HTC, HIV transition clinic; YALHA, young adults living with HIV/AIDS; (χ²), chi-square.

Table 5 Determinants of HTC utilization by YALHA

Factor	Category	cOR	95% CI	aOR	95% CI
CD4 count category(/μL)	≤250	1.00		1.00
	≥251	0.40	0.25–0.62***	0.58	0.36–0.95**
Currently on antiretroviral therapy	Yes	1.00		1.00
	No	0.22	0.13–0.38***	0.27	0.15–0.47***
Received counseling services	Yes	1.00		1.00
	No	0.44	0.26–0.74**	0.47	0.27–0.83***
Location of place of residence	Urban	1.00		1.00
	Rural	1.72	1.11–2.68**	1.59	0.98–2.58
Received laboratory services	Yes	1.00		1.00
	No	0.36	0.17–0.80**	0.52	0.22–1.22
HTC waiting time categories during visits in hours	0–1	1.00		1.00
	1–2	1.53	0.91–2.57	1.25	0.71–2.21
	>3	1.76	1.02–3.04**	1.44	0.80–2.61
Do you have a regular caregiver at home?	Yes	1.00		1.00
	No	0.46	0.24–0.86**	0.67	0.34–1.33
Sex	Male	1.00		1.00
	Female	1.01	0.57–1.74	1.04	0.56–1.93

Notes:

** P-value ≤0.001

*** P-value =0.000; log-likelihood =−207.10; Pearson l-fit prob > χ²=0.607.

Abbreviations: 95% CI, 95% confidence interval; AIDS, acquired immunodeficiency syndrome; aOR, adjusted odds ratio; cOR, crude odds ratio; HIV, human immunodeficiency virus; HTC, HIV transition clinic; YALHA, young adults living with HIV/AIDS.