Retention & Attrition of Patients on Antiretroviral Therapy for HIV/AIDS in South Africa


Paper from this study

Miller, C., Rybasack H., and Rosen, S. (2010). “Understanding retention among ARV patients in South Africa: A qualitative assessment of defaulters.” Tropical Medicine and International Health. 15(Supplement 1):48-54.

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.

Poster from this study

Reasons for loss to follow up among ARV patients in South Africa Poster presented at the 5th IAS Conference on HIV Pathogenesis Treatment and Prevention (IAS 2009), Cape Town, South Africa 19-22 July 2009 

Antiretroviral therapy (ART) for HIV/AIDS requires a lifelong commitment from patients as well as providers. For individual patients, both adherence to a specific treatment regimen and retention in the treatment program are essential to success. In this study, we will investigate the reasons for and determinants of long-term patient retention. The study will

1) estimate the rate of ART patient retention and attrition at public and NGO treatment sites in South Africa during the first three years after initiating ART;

2) describe the main reasons for attrition for patients with different characteristics and receiving care from different types of facilities; and

3) determine whether the probability of dropping out varies with specific patient characteristics.

Patients at an urban hospital and a rural clinic in South Africa who have been on ART for at least six months will be enrolled in the study and administered a baseline questionnaire focusing on issues that are hypothesized to affect retention (e.g. costs, side effects, stigma). A follow-up status review will be conducted 12 months later. Patients who have dropped out of the program will be located using contact information collected at the baseline interview and interviewed again to determine reasons for discontinuation. Findings from the study will improve the information available for ART programme design, patient care, and public sector planning. By identifying rates of and reasons for patient attrition, the study allow better targeting of interventions, indicate whether the therapeutic regimen itself can be improved to promote patient retention, and provide more accurate information on expected numbers of patients in later years of the ART rollout.

Sydney Rosen is the Principal Investigator and Dr. Ian Sanne and Dr. Candace Miller are co-Investigators.