Conceptualising the Factors Affecting Retention in Care of Patients on Antiretroviral Treatment in Kabwe District, Zambia, Using the Ecological Framework

Abstract

Background. HIV remains a major public health challenge in Zambia. The roll-out of antiretroviral treatment (ART) has engendered new challenges in retention in care. Objective. To conceptualise the factors affecting retention in care of ART patients at three primary healthcare facilities using the ecological framework. Method. Qualitative data were collected through in-depth interviews with 45 ART patients and three focus group discussions with 20 healthcare providers from three primary healthcare facilities in Kabwe district, Zambia, and subjected to thematic content analysis. Results. Individual level barriers to retention in care included side effects, gaining weight, belief in faith healing, and use of herbal remedies and alcohol. Interpersonal barriers such as stigma and nondisclosure of HIV status were reported. At the institutional level, inadequate space in the clinic, long waiting times, long travel distances, and shortage of third-line drugs presented barriers to retention in care. Food shortages and patient mobility were reported as community barriers to retention in care. Conclusion. The ecological framework conceptualises the complex and dynamic factors affecting retention in ART care and highlights the need for multifaceted interventions that combine health education, disease management, and opportunities for income generation in a socially responsive and accountable environment.

Individual, household, and community level barriers to ART adherence among women in rural Eswatini

“…This often led to lapses in ART adherence. In recent qualitative and quantitative studies conducted among countries in sub-Saharan Africa, hunger and household food insecurity were identified as major barriers to ART adherence [20,21,23,[46][47][48]. Several studies in the region have reported similar findings, and in some cases, individuals stopping treatment completely due to anxiety over side effects from ART medication when access to food was compromised and inadequate [18,19,27].…”

“…Empirical studies across settings in sub-Saharan Africa indicate that ART adherence can be influenced by risk factors operating at multiple levels. At the individual level, ART adherence is associated with age, gender, educational level, forgetfulness, ART duration, alcohol use, stress, lack of money, and lack of disclosure status [17][18][19][20][21]. At the household level, ART adherence is associated with household food insecurity, household socioeconomic status, lack of family support, and use of traditional medicine [18,20,[22][23][24].…”

“…At the individual level, ART adherence is associated with age, gender, educational level, forgetfulness, ART duration, alcohol use, stress, lack of money, and lack of disclosure status [17][18][19][20][21]. At the household level, ART adherence is associated with household food insecurity, household socioeconomic status, lack of family support, and use of traditional medicine [18,20,[22][23][24]. At the community/institutional level, ART adherence is associated with area of residence, stigma, lack of privacy and confidentiality, proximity to a health facility, transportation to a health facility, insufficient health care, and maltreatment at health facilities [17,[25][26][27].…”

Viral Load Suppression after Enhanced Adherence Counseling and Its Predictors among High Viral Load HIV Seropositive People in North Wollo Zone Public Hospitals, Northeast Ethiopia, 2019: Retrospective Cohort Study

“…is might be due to long travel distance to health facility because large proportion of participants in the current study were from rural residence. Previous studies also showed that long travel distance and lack of money for traveling to health institution affect ART adherence and follow-up visit within the recommended time [17,18]. Besides, the median time to complete the enhanced adherence counseling session was greater than 24 weeks in men, which is very far away from the suggested time [3,10,12].…”

Implications of the human immunodeficiency virus test and treat strategy on antiretroviral treatment uptake and retention outcomes in Cameroon

“…[24][25][26] This is seemingly true for this study which found a significantly higher median CD4 value in patients enrolled under the T&T. Lower retention has been reported in patients with higher CD4 count and gaining weight in Nigeria and South Africa. 27,28 In the same light, "feeling healthy'' was reported as a barrier to ART initiation and engagement by a study in Cameroon and another in Mozambique. 23,29 These suggest that proper counselling, therapeutic education and close follow up amongst healthier patients initiating ART maybe be helpful in improving ART retention, especially under the T&T context.…”