Barriers to Sustaining Antiretroviral Treatment in Kisesa, Tanzania: A Follow-Up Study to Understand Attrition from the Antiretroviral Program

Abstract

Two years after the introduction of free antiretroviral therapy (ART) in Tanzania and in spite of the logistical support provided to facilitate clinic attendance, a considerable level of attrition from the program was identified among clients from a semi-rural ward. Qualitative research on ART patients' health-seeking behavior identified factors affecting sustained attendance at treatment clinics. A mix of methods was used for data collection including semi-structured interviews with 42 clients and 11 service providers and 4 participatory group activities conducted with members of a post-test group between October and December 2006. A socio-ecological framework guided data analysis to categorize facilitators and barriers into individual, social, programmatic, and structural level influences, and subsequently explored their interaction and relative significance in shaping ART clients' behavior. Our findings suggest that personal motivation and self-efficacy contribute to program retention, and are affected by other individual-level experiences such as perceived health benefits or disease severity. However, these determinants are influenced by others' opinions and beliefs in the community, and constrained by programmatic and structural barriers. Individuals can develop the requisite willingness to sustain strict treatment requirements in a challenging context, but are more likely to do so within supportive family and community environments. Effectiveness and sustainability of ART roll-out could be strengthened by strategic intervention at different levels, with particular attention to community-level factors such as social networks' influence and support.

Early Warning Indicators for First-Line Virologic Failure Independent of Adherence Measures in a South African Urban Clinic

“…50 Individuals who were pleased with their clinic experience were more likely to be controls in all models as has been shown in other studies that described the influence of the healthcare environment on clinic attendance and adherence. 9,40,[51][52][53][54][55] . Several clinical factors were associated with VF.…”

Parental HIV disclosure in Burkina Faso: Experiences and challenges in the era of HAART

“…Nowadays, the challenges to disclosure are shifted to PLHIV who are prompted by health-care professionals to disclose to relatives, and by law, to spouses or sex partners (Sanon, Kaboré, Wilen, Smith & Galvão 2009). Sustained education and interventions for attitudinal change, coupled with institutional support, especially through local NGOs, have contributed to stigma reduction and to the creation of an enabling environment (Norman, Chopra & Kadiyala 2007;Roura, Busza, Wringe, Mbata, Urassa & Zaba 2009). …”

An Assessment of Quality Assurance in HIV and AIDS-Related Services in Chivuna Rural Health Facility of Southern Zambia

“…When clients become aware that staff are not adequately trained, they may lose confidence in the facility and possibly resort to other means such as traditional medicines which are largely neither scientifically tested nor approved. Lack of training among ART staff and its negative effects has been reported also by other qualitative studies from other countries within the region [9] [14] [17] and from Zambia [18] [19] [20]. In our study area, lack of training was compounded by lack of continuity in service delivery by health staff in that they worked at the ART clinic on a rotational basis.…”