Faith Okaalo, MPH, BS

Factors associated with retention in care among women living with HIV and those not living with HIV receiving treatment for cervical dysplasia in Western Kenya.

Faith Okaalo, Susan Cu-Uvin, Elkanah Orang’o, Juddy Wachira

Brown University, Providence, Rhode Island.
Moi University, Eldoret, Kenya.
The Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.

Women living with human immunodeficiency virus (HIV) have an elevated risk of cervical cancer as compared to women living without HIV. The risk of cervical cancer remains high in low and middle-income countries (LMICs) due to delays in seeking care and loss to follow-up after abnormal screening results. LMICs such as Kenya report about 41–69% of loss to follow-up for cervical dysplasia patients. To maximize the benefits of early detection and prompt treatment of precancerous lesions it is important to understand factors that affect follow-up among patients with abnormal screening results. This study explored the facilitators and barriers to engagement and retention in care among women diagnosed with cervical dysplasia at AMPATH, Western Kenya.

This qualitative descriptive study was done among women who had abnormal cervical screening results on histology between 2019 and 2020. Convenience sampling was used to recruit 18 cervical dysplasia patients in care and 16 lost to follow-up. Patients were considered lost to follow-up if they were contacted and reminded of their follow-up appointment and did not go for their checkup within six months after any missed visit. In-depth interviews were conducted between June and August 2022. Data were managed using NVivo10 and analyzed using thematic analysis.

Our study findings revealed that factors at multiple levels, such as individual patient characteristics (embarrassment and pain associated with the treatment and follow-up procedures, financial factors), interpersonal factors (social/family support), provider-patient relationships (gender of healthcare providers, communication and decision making by healthcare providers), and facility-level factors (patient reminder systems) affect adherence to follow-up among cervical dysplasia patients.

Understanding the healthcare environment and the various levels of influence in treating cervical dysplasia patients is crucial in developing multifaceted interventions to promote retention in care and thus reduce cervical cancer incidence in Kenya.