Reasons for Defaulting from Public art Sites in Addis Ababa
Creators: name: Akalu, Addis
Publisher: name: National Academic Digital Repository of Ethiopia
Year: 2009

description: Background: The outcome of patients on ART is, usually categorized, as patients alive on treatment, transferred out to other health facility, dead or lost to follow up. "Lost to follow up" is considered if he/she has missed more than three scheduled clinic visits or has not been seen for at least 3 months after the initiation of cART. (After single or more visits). As ART programs scales up attrition of patients from the treatment creates a great challenge for developing countries such as Ethiopia and the ART clinic have limited capacity to track effectively lost to follow up and address the pressing question why patients drop out and what condition needed to retain them. Objectives: To assess reasons for defaulting from ART program at hospital based ART sites in Addis Ababa. Methods: A case-control study, on reasons for defaulting from ART carried out between Februarys to June 2009 in three public hospital- based ART sites in Addis Ababa. Both cases and controls were selected among patients who started receiving ART during a period of March 1, 2005 to March 31, 2008. Cases were patients who were absent from clinic visit for&gt;= 3 months after the initiation of HAART &amp; controls were those who are alive and on ART Cases were traced actively through telephone calls or home visits .Controls selected by paired matching of sex and age using lottery method from the list of active ART users who came to the hospital to collect their medication at the day of their appointment. Two controls were matched to each case. Both case and controls were interviewed by trained interviewers using pre tested structured questionnaires. The two groups were compared by social, demographic and health 8 service variables. The over all lost to follow up rate and specific rate by month of defaulting&amp; health institutions were calculated. . Results: 1499 lost to follow ups were included in the study. 87%were on WHO clinical stage 3 and 4 and had a median CD4 count of 50 at the start of treatment .The over all lost to follow up rate from ART found to be 21% among 6992 ART patients who started treatment between a period of March 2005to March 2008. During active tracing 471(31.4%) were reported dead and 198(13%) traced were alive while the rest (55%) could not be traced. Defaulting occurred within 3 months after the start of ART. Traced alive and interviewed 103cases (defaulters) matched with 206 controls. Unemployment (AOR=2.162) with CI of 1.08 to 4.22) and monthly household income (AOR=0.09 with CI 0.011, 0.73) was found to be significantly associated with defaulting. Opting out for religious/alternative healing and clinic transfer were the reasons mentioned for treatment interruption in most cases. Conclusions: The majority of lost to follow ups were enrolled for treatment at advanced stage of HIV illness. Large proportion could not be traced due to the wrong address included in the ART register. Death is found to be the main reason for treatment default .Unemployment and economical constraints are the main determinant factors of treatment interruptions. Recommendations: ART clinics with effective pre ART programs that can identify pool of eligible patients for ART and enroll timely into the ART cohorts, that have active patient tracking mechanisms &amp; linkage with community and faith based organizations should be strengthened.