Factors affecting patients on antiretroviral therapy lost to follow up in Asunafo South District of Ahafo Region, Ghana: Cross-sectional Study
Authors: Kogi Robert , Krah Theresa , Asampong Emmanuel , Kamau Edward Mberu 
Published: January 2024

Background

Despite the increased and effective program coverage for antiretroviral therapy (ART), a considerable proportion of individuals receiving ART discontinue medication at different stages of their treatment pathway. In sub-Saharan Africa, approximately half of individuals who test positive for HIV are lost to follow-up. This study was set out to answer the following question “What are the factors that affect patients on ART loss to follow-up in Asunafo South District of Ghana?”

Methodology

Cross-sectional study design with systematic random sampling was employed to select HIV patients on ART and those lost to follow-up. Stata 17.0 was used to analyze the data. A cox-proportional hazard regression was fitted in order to determine the predictor variables. Variables for the multivariable cox-proportional hazard regression model were chosen by entering the outcome variable (loss to follow-up) and explanatory variables into the model. Lastly, the association between the explanatory and outcome factors was determined using the adjusted hazard ratios and their associated 95 percent confidence interval considered.

Findings

Patients who began antiretroviral therapy at age 41 years or older had a significantly lower chance of being lost to follow-up than those who began ART at age 35 or less. Furthermore, patients who started ART with a primary education had 1.68-fold increased risk of lost to follow-up compared to patients with no education. In addition, patients in rural locations had a 2.65-fold higher likelihood of being lost to follow-up than patients in urban areas. The main reasons for missing ART appointments among patients included walking long distance to clinic, cost of transportation, fear of scolding from clinic staff, stigma, and erratic supply of antiretrovirals. In conclusion, to reduce HIV patients lost to follow-up, all clinicians and stakeholders should take into account the risk factors that have been identified when providing ART services and counselling.

Key Messages

The existing knowledge on the topic is that despite increased and effective program coverage for antiretroviral therapy, a substantial proportion of individuals discontinue medication during various stages of treatment, particularly in sub-Saharan Africa, where approximately half of HIV-positive individuals are lost to follow-up or do not undergo eligibility assessments for therapy after testing positive.

As a result of this study, we now know that initiating antiretroviral therapy at age 41 or older, having no formal employment, residing in urban areas, and possessing a higher education level are associated with a significantly lower risk of lost to follow-up among HIV patients, and addressing factors such as long-distance travel, transportation costs, fear of stigma, and antiretroviral supply issues are crucial in reducing patient attrition from ART.

Finally, this study emphasized the importance of considering these factors in providing comprehensive ART services and counseling to reduce HIV patient disengagement from ART.