Description
- Abstract:
- Background: Poor retention in HIV care challenges the success of antiretroviral therapy (ART). This study assessed how well patients stay in care and explored factors associated with retention in the context of an initial ART rollout in Sub-Saharan Africa. Methods: We conducted a mixed-methods study at a teaching hospital in Addis Ababa, Ethiopia. A cohort of 385 patients was followed for a median of 4.6 years from ART initiation to lost-to-follow-up ((LTFU—missing appointments for more than three months after last scheduled visit or administrative censoring). We used Kaplan-Meier plots to describe LTFU over time and Cox-regression models to identify factors associated with being LTFU. We held six focus group discussions, each with 6–11 patients enrolled in care; we analyzed data inductively informed by grounded theory.Results: Patients in the cohort were predominantly female (64%) and the median age was 34 years. Thirty percent were LTFU by study’s end; the median time to LTFU was 1,675 days. Higher risk of LTFU was associated with baseline CD4 counts <100 and >200 cells/μL (HR=1.62; 95% CI:1.03–2.55; and HR=2.06; 95% CI:1.15–3.70, respectively), compared with patients with baseline CD4 counts of 100–200 cells/μL. Bedridden participants at ART initiation (HR= 2.05; 95% CIs [1.11-3.80]) and those with no or only primary education (HR=1.50; 95% CIs [1.00-2.24]) were more likely to be LTFU. Our qualitative data revealed that fear of stigma, care dissatisfaction, use of holy water, and economic constraints discouraged retention in care. Social support and restored health and functional ability motivated retention. Conclusion: Complex socio-cultural, economic, and health-system factors inhibit optimum patient retention. Better tracking, enhanced social support, and regular adherence counseling addressing stigma and alternative healing options are needed. Intervention strategies aimed at changing clinic routines and improving patient–provider communication could address many of the identified barriers.
- Notes:
- This study was supported by the Department of Sociology and the Graduate School of Northwestern University, and by grant number T32HS000011 from the Agency for Healthcare Research and Quality
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- This work is licensed under a Creative Commons Attribution 4.0 International License
Citation
Tiruneh, Yordanos M., Galárraga, Omar, Genberg, Becky L., et al.,
"Data for 'Retention in care among HIV-infected adults in Ethiopia, 2005-2001: a mixed-methods study'"
(2016).
Brown University Open Data Collection.
Brown Digital Repository. Brown University Library.
https://doi.org/10.7301/Z0VT1Q1M
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Brown University Open Data Collection
This collection contains open and public access data sets created by Brown University faculty and student researchers. Increasingly, publishers and funders are requiring that protocols, data sets, documentation and code underlying publications be retained and preserved in repositories, their locations …...