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Why are antiretroviral treatment patients lost to follow-up? A qualitative study from South Africa

Authors: Miller, Candace M.1; Ketlhapile, Mpefe2; Rybasack-Smith, Heather1; Rosen, Sydney

Source: Tropical Medicine & International Health, Volume 15, Supplement 1, June 2010 , pp. 48-54(7)

Publisher: Wiley-Blackwell

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Summary Objectives 

To better understand the reasons why patients default from antiretroviral treatment (ART) programmes to help design interventions that improve treatment retention and ultimately, patient outcomes. Methods 

Prospective cohort study at two treatment sites in South Africa followed by qualitative interviews with patients that had defaulted. Results 

Respondents overwhelmingly reported that ART improved their health status and quality of life. Nevertheless, despite improved health from taking ART and worse health when treatment is stopped, serious barriers to treatment remained: transport costs, time needed for treatment, and logistical challenges were barriers to treatment, whereas stigma around HIV/AIDS, and side effects associated with ART were less influential. Conclusion 

With a better understanding of the reasons for defaulting, interventions can be designed that improve treatment retention and ultimately, patient outcomes. This study argues for realistic interventions and policy changes designed to reduce the financial and time burden of ART and to reduce logistical barriers, such as simplifying the referral and transfer process, employing patient advocates, and adopting extended and weekend clinic hours.

Keywords: South Africa; antiretroviral therapy; loss to follow-up; qualitative research

Document Type: Research Article


Affiliations: 1:  Center for Global Health and Development, Boston University, Boston, MA, USA 2:  Health Economics and Epidemiology Research Office, Wits Health Consortium, Themba Lethu Clinic, Johannesburg, South Africa

Publication date: June 1, 2010

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