English

Abstract

Importance: With increasing number of persons living with Human Immunodeficiency Virus (HIV) in major cities there is a need to have a comprehensive strategy to reduce the number of drop outs from the anti-retroviral (ART) therapy. This can be done effectively only when we study the reasons why patients are lost to follow up. This study has brought to light novel causes of non- adherence to ART, like migration, discordance and resort to alternative therapies. DESIGN: This is a qualitative study conducted at ART Center, Byramjee Jeejeebhoy Medical College (BJMC) and Sassoon General Hospital (SGH), Pune, a tertiary referral center in India. We included all those patients who were initiated antiretroviral therapy and lost to follow-up (LFU) any time during the entire month after three months during which the appointment was scheduled. All these patients were interviewed during restart of ART, in ART center, BJMC and SGH. MAIN OUTCOMES AND MEASURES: All socio- demographic and clinical factors associated with antiretroviral therapy adherence. RESULTS: Out of a total 51patients lost to follow-up, patients above thirty five years of age and male sex were associated with a higher chance of being lost to LFU. Illiteracy rate was high in age group above 35 years (64.1%) and in females. Male drivers were lost to follow-up at a greater extent (14(24.75%)). Out of 24(47.06%) married patients, 12(50%) male patients were sero-discordant. The chance of defaulting from therapy was high in the first three months and one year later from the initiation of therapy. Migration led to drop out of 13(25.49%) patients. Other important factors leading to loss to follow up were: death in family, side effects of drugs and family disturbance. Alcoholism was the cause in 23(45.10%) male patients. CONCLUSION AND RELEVANCE: Migration, illiteracy, alcoholism, discordant couples, death in family, low socio-economic status, resorting to alternative therapies were the prominent factors which directly influenced and aggravated the problem of non- adherence. Targeting these variables will cause definite reduction in lost to follow-up cases.