Table 3. Multivariate analysis of comprehensive retention in care among 13 331 HIV-positive patients enrolled in care at 63 facilities in the Eastern and Nyanza regions of Kenya, January 2014 to March 2016.
| Variable | Patients retained in comprehensive care for 12 monthsa (yes/no) |
|
|---|---|---|
| Model 1b RRc (95% CI) |
Model 2b RRc (95% CI) |
|
| Initiation of ART by nursed | ||
| Yes | 1.25 (1.01–1.54) | 1.22 (1.00–1.48) |
| No | Ref. | Ref. |
| Physician at HIV clinic | ||
| Yes | 0.82 (0.61–1.10) | 0.83 (0.64–1.09) |
| No | Ref. | Ref. |
| Patient volume, no. of new enrollees per year | ||
| < 150 | 1.04 (0.84–1.30) | 1.05 (0.86–1.28) |
| 150–300 | 0.90 (0.73–1.12) | 0.92 (0.76–1.12) |
| > 300 | Ref. | Ref. |
| Facility type | ||
| Public primary | 1.04 (0.88–1.22) | 0.98 (0.84–1.14) |
| Public secondary | Ref. | Ref. |
| Private | 1.01 (0.77–1.32) | 1.00 (0.96–1.05) |
| Age, years | ||
| < 2 | N/A | 0.93 (0.81–1.06) |
| 2–14 | N/A | 1.03 (0.93–1.15) |
| 15–24 | N/A | 0.96 (0.89–1.04) |
| 25–39 | N/A | Ref. |
| 40–49 | N/A | 0.93 (0.84–1.02) |
| 50+ | N/A | 0.98 (0.91–1.04) |
| Sex | ||
| Male | N/A | 1.00 (0.96–1.05) |
| Female | N/A | Ref. |
| Immune status at enrolment | ||
| CD4+ cell count > 200 cells/µL, or WHO stage 1 or 2 | N/A | Ref. |
| CD4+ cell count ≤ 200 cells/µL, or WHO stage 3 or 4 | N/A | 0.65 (0.60–0.70) |
| Unrecorded | N/A | 0.74 (0.70–0.78) |
ART: antiretroviral therapy; CD4+ cell: CD4+ T lymphocyte; CI: confidence interval; HIV: human immunodeficiency virus; N/A: not applicable; Ref.: reference category; RR: relative risk; WHO: World Health Organization.
a Patients achieved 12 months of retention in comprehensive HIV care if they were: assessed for ART eligibility (CD4+ cell count or WHO stage); initiated on ART, if eligible; and retained on ART for 12 months after enrolment, or retained in care for 12 months if ART ineligible.
b Model 1 included only facility-level covariates. Model 2 included facility-level and patient-level covariates. Facility type was a priori identified as a potential confounder of the relationship between availability of ART initiation and management by a nurse and retention at 12 months. Other facility-level covariates found significant at α < 0.05 in the univariate model were included in the multivariable models. All three patient-level covariates were included in the models.
c Relative risks of achieving 12-month retention in care were calculated using generalized linear mixed log-binomial relative risk regression with random intercepts to account for within-clinic correlation.
d Because eligibility assessment by nurse, initiation of ART by nurse and follow-up of ART by nurse were highly collinear with each other, only nurse initiation of ART by nurse was included in the models.
Note: Data were collected for patients enrolling in HIV care between 1 January 2014 and 31 March 2015 and followed up to 31 March 2016.