TY - JOUR
T1 - Patient-reported Reasons for Stopping Care or Switching Clinics in Zambia
T2 - A Multisite, Regionally Representative Estimate Using a Multistage Sampling-based Approach in Zambia
AU - Sikazwe, Izukanji
AU - Eshun-Wilson, Ingrid
AU - Sikombe, Kombatende
AU - Beres, Laura K.
AU - Somwe, Paul
AU - Mody, Aaloke
AU - Simbeza, Sandra
AU - Bukankala, Chama
AU - Glidden, David V.
AU - Mulenga, Lloyd B.
AU - Padian, Nancy
AU - Ehrenkranz, Peter
AU - Bolton-Moore, Carolyn
AU - Holmes, Charles B.
AU - Geng, Elvin H.
N1 - Publisher Copyright:
© 2021 Oxford University Press. All rights reserved.
PY - 2021/10/1
Y1 - 2021/10/1
N2 - 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 clinicbased 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 patientreported barriers.
AB - 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 clinicbased 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 patientreported barriers.
KW - HIV
KW - Zambia
KW - disengagement
KW - reasons
KW - retention
UR - http://www.scopus.com/inward/record.url?scp=85106616843&partnerID=8YFLogxK
U2 - 10.1093/cid/ciaa1501
DO - 10.1093/cid/ciaa1501
M3 - Article
C2 - 33011803
AN - SCOPUS:85106616843
SN - 1058-4838
VL - 73
SP - E2294-E2302
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 7
ER -