Defaulters from antiretroviral treatment in Jimma University Specialized Hospital, Southwest Ethiopia

Jimma University Faculty Of Public Health Department Of General Public Health, Jimma, Ethiopia.
Tropical Medicine & International Health (Impact Factor: 2.33). 04/2008; 13(3):328-33. DOI: 10.1111/j.1365-3156.2008.02006.x
Source: PubMed


To determine the prevalence of and factors associated with defaulting from antiretroviral treatment (ART) in Jimma, Ethiopia.
Unmatched case control study: cases were individuals who had missed two or more clinical appointments (i.e. had not been seen for the last 2 months) between January 2005 and February 2007; controls were individuals who had been on ART at least for 1 year and were rated as excellent adherers by the providers. Data were collected from patient records, and by telephone call and home visit to identify the reason for defaulting.
Of 1270 patients who started ART, 915 (72.0%) were active ART users and 355 (28.0%) had missed two or more clinical appointments. The latter comprised 173 (13.6%) defaulters, 101 (8.0%) who transferred out, 75 (5.9%) who died, and 6 (0.5%) who restarted ART. Reasons for defaulting were unclear in most cases. Reasons given were loss of hope in medication, lack of food, mental illness, holy water, no money for transport, and other illnesses. Tracing was not successful because of incorrect address on the register in 61.6% of the cases. Taking hard drugs (cocaine, cannabis and IV drugs), excessive alcohol consumption, being bedridden, living outside Jimma town and having an HIV negative or unknown HIV status partner were associated with defaulting ART.
A significant proportion of patients defaulted from ART treatment. ART clinics should ensure that patients' addresses are correct and complete. Programmatic and counseling efforts to decrease ART defaulting should address illicit drug and excessive alcohol use, decentralise ART services, institute home-based treatment options for seriously ill and bedridden patients, and address patients concerns.

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    • "Similar results were found in rural Uganda, Malawi, Cambodia and India [49-52]. Finance (costs for food and shelter, in addition to the transport cost) was reported to be a bottleneck for linkage and retention in care in Ethiopia [45,46]. In South Africa and Uganda, around 35% of patients stated finance as a reason for absence from clinic visits [53,54]. "
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    ABSTRACT: Background Antiretroviral treatment (ART) was provided to more than nine million people by the end of 2012. Although ART programs in resource-limited settings have expanded treatment, inadequate retention in care has been a challenge. Ethiopia has been scaling up ART and improving retention (defined as continuous engagement of patients in care) in care. We aimed to analyze the ART program in Ethiopia. Methods A mix of quantitative and qualitative methods was used. Routine ART program data was used to study ART scale up and patient retention in care. In-depth interviews and focus group discussions were conducted with program managers. Results The number of people receiving ART in Ethiopia increased from less than 9,000 in 2005 to more than 439, 000 in 2013. Initially, the public health approach, health system strengthening, community mobilization and provision of care and support services allowed scaling up of ART services. While ART was being scaled up, retention was recognized to be insufficient. To improve retention, a second wave of interventions, related to programmatic, structural, socio-cultural, and patient information systems, have been implemented. Retention rate increased from 77% in 2004/5 to 92% in 2012/13. Conclusion Ethiopia has been able to scale up ART and improve retention in care in spite of its limited resources. This has been possible due to interventions by the ART program, supported by health systems strengthening, community-based organizations and the communities themselves. ART programs in resource-limited settings need to put in place similar measures to scale up ART and retain patients in care.
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    • "While various reasons are known, demonstrating associations between various variables and risk of becoming LTFU remains challenging. Reported reasons for LTFU in Malawi and elsewhere have included: food insecurity [13-15], financial constraints [14,16,17], religious and family influences [14,16,18,19], wanting to access traditional medicine [20], stigma and fear of disclosure of HIV status [10,19-22], living far from clinics and transport-related costs [10,14,18,20,23], and poor patient-provider relationships [10,14,20]. Treatment literacy (e.g., understanding the natural course of treatment and the need for adherence to ART) [24,25], experiencing an improvement in health and believing that treatment is no longer necessary [10] may also matter. "
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    ABSTRACT: Background Retention in antiretroviral therapy (ART) programmes remains a challenge in many settings including Malawi, in part due to high numbers of losses to follow-up. Concept Mapping (CM), a mix-method participatory approach, was used to explore why patients on ART are lost to follow-up (LTFU) by identifying: 1) factors that influence patient losses to follow-up and 2) barriers to effective and efficient tracing in Zomba, Malawi. Methods CM sessions (brainstorming, sorting and rating, interpretation) were conducted in urban and rural settings in Zomba, Malawi. Participants included ART patients, ART providers, Health Surveillance Assistants, and health managers from the Zomba District Health Office. In brainstorming, participants generated statements in response to “A specific reason why an individual on ART becomes lost to follow-up is…” Participants then sorted and rated the consolidated list of brainstormed items. Analysis included inductive qualitative methods for grouping of data and quantitative cluster identification to produce visual maps which were then interpreted by participants. Results In total, 90 individuals brainstormed 371 statements, 64 consolidated statements were sorted (participant n = 46), and rated on importance and feasibility (participant n = 69). A nine-cluster concept map was generated and included both patient- and healthcare-related clusters such as: Stigma and Fears, Beliefs, Acceptance and Knowledge of ART, Access to ART, Poor Documentation, Social and Financial Support Issues, Health Worker Attitudes, Resources Needed for Effective Tracing, and Health Worker Issues Related to Tracing. Strategies to respond to the clusters were generated in Interpretation. Conclusions Multiple patient- and healthcare focused factors influence why patients become LTFU. Findings have implications particularly for programs with limited resources struggling with the retention of ART patients.
    Full-text · Article · Jun 2013 · BMC Health Services Research
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    • "When comprehensive care and patient self-management fail, patients discontinue treatment and develop rapid viral rebound and loss of CD4 T lymphocytes [24], which significantly increases the risk of drug resistance and treatment failure. In addition, patients with clinical AIDS who discontinue ART will probably die within a relatively short time [24]. "
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    Full-text · Article · Jul 2012 · BMC Health Services Research
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