Low retention in care among HIV positive patients receiving antiretroviral treatment in Dodoma, Tanzania

Abstract

Abstract Low retention in care among HIV positive patients receiving antiretroviral treatment in Dodoma, Tanzania Degree Project in Medicine Jenny Bodell Supervisors: Prof. Rune Andersson, Professor in Global Health, MD, PhD Institute of Biomedicine, University of Gothenburg, Sweden, Dr Boniface Nguhuni, MD, Medical Coordinator, Dodoma Regional Referral Hospital, Tanzania and Dr Siraj Shaban, MD, Dodoma Regional Referral Hospital, Tanzania Introduction There have been great scale-ups of antiretroviral therapy (ART) in sub-Saharan Africa recent years. ART is very efficient in treating HIV, but it needs to be taken with strict adherence and life-long. Thus, the current challenge is to keep patients in the treatment programmes. Aims The aim of this study was to find the proportion of patients starting ART 2012-2015 that remain in treatment the following four years at Dodoma Regional Referral Hospital. Furthermore, to find out whether patients lost to follow-up differed from patients remaining in care. Finally, to find out about patients´ experiences of being treated with ART. Methods Data was gathered from Dodoma Regional Referral Hospital´s local database concerning 2333 patients, from 200 patient files and from 100 answered questionnaires. SPSS was used for analysing data. Results Retention in treatment was 60% one year after treatment start, with further decrease to 47% after four years. Patients starting ART 2012 were more likely to remain in care than patients starting later. Having advanced HIV classified as WHO clinical stage 3 at treatment start was found to be a factor that increased the risk of being lost to follow-up (OR 3.19, 95% CI 1.81- 8.59). Incomplete adherence was shown in 22% of patients, where patients had missed to take at least one dose of ART the last four weeks before time of investigation. Side effects increased the risk for poor adherence. Stigma was seen; 22% of patients chose not to tell others about being HIV positive because of fear of being discriminated and 10% because of fear of being excluded from their families. Conclusions and implications Retention in treatment was low and needs to be increased. By inquiring for factors associated with being lost to follow-up patients in need of extra resources to remain in treatment could be identified. Keywords Antiretroviral therapy, retention, adherence, Tanzania.