DOI: 10.3886/e227941v1
title: Patient related factors associated with ART defaulting among the youth accessing HIV care services in Mzimba, Malawi

description: Antiretroviral therapy (ART) defaulting is a serious problem among youth
accessing Human immunodeficiency virus (HIV) care services in Malawi. It leads
to development of drug resistance, treatment failure and increased client
mortality. This study aimed at assessing patient factors influencing ART
defaulting amongst youth living with HIV enrolled on ART in Mzimba District.

<b>Methods:</b> A quantitative, case-control
design was employed, enrolling 411 youths living with HIV (n=137 cases and
n=274 controls) attending an HIV care clinic. The cases and controls were
allotted to the ART clinics proportionally to their number of ART clients. Random
sampling techniques were used to recruit both ART defaulters and
non-defaulters. Data were collected using a structured questionnaire and
analyzed using Statistical Package for Social Sciences (SPSS) version 20.0. Descriptive
statistics provided counts, frequencies, proportions, and ranges, while
inferential statistics established associations between dependent and
independent variables.

<b>Results:</b> Patient
related factors associated with ART defaulting include: forgetting appointment
date (p-value: &lt;0.001, OR: 4.213, 95% CL: 2.289-7.755), experiencing ART
side effects (p-value: &lt;0.001, OR: 0.438, 95% CL: 0.286-0.672), taking other
drugs apart from ARVs (p-value 0.008, OR: 0.059, 95% CL: 0.007-0.479). ART
defaulting was also associated with presence of a psychological disorder among
the participants (SRQ statement 7_8) (p-value &lt;0.001, OR: 22.119, 95% CL:
10.81-45.26) and having suicidal ideas in the participants (p-value
&lt;0.001, OR: 0.111, 95%CL: 0.051-0.241). Seventeen percent (17%)
of the youths had psychological disorders, 10% suicidal thoughts, 20.0%
anxiety, 12.4% felt worthless, 19.2% troubled mind, 24.8% headache and
abdominal discomfort (23.8%)
description: Response Rates: About 95 % of the targeted participants responded to the questionnaires.
description: Presence of Common Scales: Yes or no questions were used
description: This case-control study required a sample of 411 participants. Calculated using a formula for case- control studies adapted from Charan and Biswas, a 1: 2 ratio of cases to controls was determined. A two stage cluster random sampling technique was used. The
first phase that determined health facilities for the study used simple random
sampling. Names of the health
facilities were written on a piece of paper, folded and placed in a closed box.
A volunteer was requested to draw one paper at a time, after shaking the box. Each drawn name was read aloud and recorded on an A4 sheet of paper
for inclusion in the study. The process was repeated until four health
facilities were selected: Mzimba District Hospital, Embangweni Hospital, Jenda
Health Centre, and Euthini Health Centre. In the second phase, stratified
random sampling was used to recruit participants (cases and controls) from the
facilities in a 1:2 ratio. At each facility, two cartons were prepared—one
containing identity numbers of defaulters and the other containing identity
numbers of non-defaulters. To select cases, a volunteer randomly drew identity
numbers from the defaulters’ carton, one at a time after thoroughly shaking it,
until the required number of cases for the respective facility was achieved.
The same procedure was applied to the non-defaulters’ carton to recruit
controls, ensuring the target sample size for each health facility was met.<br>
description: face-to-face interview;