Abstract
BackgroundRetention 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.MethodsCM 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.ResultsIn 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.ConclusionsMultiple 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.
Highlights
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
By June 2010, approximately 58% of those in need were receiving antiretroviral therapy (ART) [5] disparities continue to exist in access to treatment options, for individuals living in rural areas [6]
Provider participants consisted of ART providers, Health Surveillance Assistants (HSAs) involved with patient tracing, and members of the Zomba District Health Office (DHO) health management team involved in ART provision
Summary
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. 34 million people were living with HIV/AIDS by December 2010 and the majority resided in subSaharan Africa [1]. In Malawi, the prevalence of HIV is estimated as 11% [2,3] and over 650,000 children have been orphaned by AIDS [4]. By June 2010, approximately 58% of those in need were receiving antiretroviral therapy (ART) [5] disparities continue to exist in access to treatment options, for individuals living in rural areas [6]. Losses to follow-up (LTFU) from antiretroviral therapy is a major cause of patient attrition [7]. Patients who discontinue treatment are vulnerable to drug resistance, AIDS-related illnesses, and death [7,8,10,11,12]
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