Predictors of antiretroviral therapy interruptions and factors influencing return to care at the Nkolndongo Health District, Cameroon

Abstract

Background: Antiretroviral therapy is a lifelong commitment that requires consistent intake of tablets to optimize health outcomes, attain and maintain viral suppression. Objective: We aimed to elicit predictors of treatment interruption amongst PLHIV and identify motivating factors influ- encing return to care. Method: We conducted a cross-sectional study using a mixed-method approach in four hospitals in Yaoundé. Sociodemo- graphic and clinical data were collected from ART registers. Using purposeful sampling, thirteen participants were enrolled for interviews. Quantitative data were analyzed using Epi-Info and Atlas-TI for qualitative analysis. Ethical clearance ap- proved by CBCHS-IRB. Results: A total of 271 participants records were assessed. The mean age was 33 years (SD±11years). Private facilities CASS and CMNB registered respectively 53 (19.6%) and 14 (5.2%) participants while CMA Nkomo and IPC had 114 (42.1%) and 90 (33.2%) participants. Most participants (75.3%) were females [OR 1.14; CI 0.78-1.66] compare with males. 78% had no viral load test results. Transport cost and stigmatization constituted the most prominent predictors of treatment interruption (47.5%) and (10.5%) respectively. Belief in the discovery of an eminent HIV cure and the desire to raise offspring motivated 30% and 61%, respectively to resume treatment. Conclusion: Structural barriers like exposed health facility, and dispensing ARVs in open spaces stigmatizes clients and increases odds of attrition. Attrition of patients on ART will be minimized through implementation of client centered ap- proaches like multiplying proxy ART pick points, devolving stable clients to community ARV model.
 Keywords: ART interruption; attrition; return to care; predictors; motivating factors; Cameroon.

Reasons for disengagement from antiretroviral care in the era of “Treat All” in low‐ or middle‐income countries: a systematic review

“…Among the 21 studies, three were conference abstracts [ 12 , 13 , 14 ] and the remainder were full papers (Table 1 ). Six studies were about general adult populations [ 12 , 14 , 15 , 16 , 17 , 18 ], nine were about women who started ART while pregnant [ 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ] and six were about various smaller populations (people who use drugs [ 13 ], indigenous people in an isolated area [ 28 ], adolescents [ 29 ], gay/bisexual/other men who have sex with men [ 30 ], men only [ 31 ] and women only [ 32 ]). No studies included children.…”

“…The number of included disengaged participants per study ranged from 6 to 5008 people. Nine studies had quantitative surveys [ 12 , 13 , 15 , 16 , 19 , 20 , 21 , 32 , 33 ] (including studies where this was done alongside in‐depth interviews) and 14 studies included at least some information about how frequently various reasons were reported by participants [ 12 , 13 , 14 , 15 , 16 , 17 , 19 , 20 , 21 , 22 , 23 , 24 , 31 , 32 ].…”

Barriers and facilitators for interventions to improve ART adherence in Sub-Saharan African countries: A systematic review and meta-analysis

“…Thirty studies [ 18 , 31 – 59 ] reported barriers to ART adherence and 11 of the studies [ 31 – 34 , 37 , 39 , 43 , 46 , 53 , 55 , 56 ] also reported facilitators to ART adherence. Both the barriers and facilitators can be grouped under the same seven broad categories–patient, health system, medication, stigma, poor mental health, socio-economic and socio-cultural-related factors ( Table 4 ).…”