Patient-reported Reasons for Stopping Care or Switching Clinics in Zambia: A Multisite, Regionally Representative Estimate Using a Multistage Sampling-based Approach in Zambia. (3rd October 2020)

• Record Type: Journal Article
• Authors: Sikazwe, Izukanji; Eshun-Wilson, Ingrid; Sikombe, Kombatende; Beres, Laura K; Somwe, Paul; Mody, Aaloke; Simbeza, Sandra; Bukankala, Chama; Glidden, David V; Mulenga, Lloyd B; Padian, Nancy; Ehrenkranz, Peter; Bolton-Moore, Carolyn; Holmes, Charles B; Geng, Elvin H
• Is Part Of: Clinical infectious diseases. Volume 73:Number 7(2021)
• Page Start: e2294
• Page End: e2302
• Publication Date: 2020-10-03
• Subjects: retention -- disengagement -- reasons -- HIV -- Zambia; Communicable diseases -- Periodicals; 616.905
• DOI: 10.1093/cid/ciaa1501
• Languages: English
• ISSNs: 1058-4838

Abstract

Abstract: Background: Understanding patient-reported reasons for lapses of retention in human immunodeficiency virus (HIV) treatment can drive improvements in the care cascade. A systematic assessment of outcomes among a random sample of patients lost to follow-up (LTFU) from 32 clinics in Zambia to understand the reasons for silent transfers and disengagement from care was undertaken. Methods: We traced a simple random sample of LTFU patients (>90 days from last scheduled visit) as determined from clinic-based electronic medical records from a probability sample of facilities. Among patients found in person, we solicited reasons for either stopping or switching care and predictors for re-engagement. We coded reasons into structural, psychosocial, and clinic-based barriers. Results: Among 1751 LTFU patients traced and found alive, 31% of patients starting antiretroviral therapy (ART) between 1 July 2013 and 31 July 2015 silently transferred or were disengaged (40% male; median age, 35 years; median CD4 level, 239 cells/μL); median time on ART at LTFU was 480 days (interquartile range, 110–1295). Among the 544 patients not in care, median prevalences for patient-reported structural, psychosocial, and clinic-level barriers were 27.3%, 13.9%, and 13.4%, respectively, and were highly variable across facilities. Structural reasons, including, "relocated to a new place" were mostly cited among 289 patients who silently transferred (35.5%). We found that men were less likely to re-engage in care than women (odds ratio, .39; 95% confidence interval, .22–.67; P = .001). Conclusions: Efforts to improve retention of patients on ART may need to be tailored at the facility level to address patient-reported barriers. Abstract : Structural, psychosocial, and clinical reasons for disengagement are prevalent and highly variable across facilities. Men are less likely to re-engage in care than women. Patients reporting clinical barriers have less likelihood of returning to care if they report a psychosocial barrier.