Prevalence and factors associated with non-adherence to post VMMC scheduled follow-up services among adults circumcised at Kisenyi Health Centre IV, Kampala, Uganda

Abstract

Background: Voluntary Medical male circumcision has been shown to decrease HIV transmissions by 60% and the increasing number of men receiving (VMMC) has a substantial impact on HIV incidence. It is now well documented that 37-39% of men globally are circumcised and for all men circumcised follow-up visits are recommended, however, adherence is variable. A high proportion of men fail to return for their scheduled post-operative visits, and this largely limits the knowledge about the clinical status of clients and adverse events of those who do not come back to the health facility. Objective: The objective of this study was to determine the prevalence and factors associated with non- adherence to post VMMC scheduled follow-up visits among adults circumcised and to understand reasons for non-adherence to scheduled visits at Kisenyi Health Centre IV, Kampala. Methods: This was a prospective Cohort study that employed both quantitative and qualitative methods. These clients were recruited immediately after circumcision. Any client who managed to attend at least one follow-up visit was regarded as adherent and those who missed all the visits were regarded as non-adherent. 10 In-depth Interviews were conducted for the qualitative data collection and clients were purposively selected. 325 adult circumcised men were recruited using systematic sampling technique. The qualitative data were analyzed using inductive thematic analysis in Atlas ti software version 6 and results presented under different themes. Quantitative data were analyzed using STATA version 14.0. The Univariate, Bivariate, and multivariate analyses were conducted and results were presented using measures of central tendency, dispersion, and associations Results: Overall, non-Adherence to post VMMC scheduled follow-up visits was high, 72.0(66.876.7) and the major facilitators were; level of education, Instruction on follow-up, source of information on follow-up and reasons for follow-up. Non adherence to VMMC scheduled services was attributed to; having busy schedules, prioritizing private consultations for quality care, among others. Adherence to VMMC services was as low as 28(23.4-33.1) and closeness to the health facility, free services, perceived health benefits, good attitude form Health workers were some of the motivators. Conclusion: Non-Adherence to post VMMC scheduled follow-up service was high at 72%, among circumcised men, and was positively associated with the level of education, instructions on followup, source of information on follow-up and reasons for follow-up.