Vital status of pre-ART and ART patients defaulting from care in rural Malawi
Article first published online: 29 APR 2010
© 2010 Blackwell Publishing Ltd
Tropical Medicine & International Health
Special Issue: Retention of patients in HIV/AIDS care and treatment programs in sub-Saharan Africa
Volume 15, Issue Supplement s1, pages 55–62, June 2010
How to Cite
McGuire, M., Munyenyembe, T., Szumilin, E., Heinzelmann, A., Le Paih, M., Bouithy, N. and Pujades-Rodríguez, M. (2010), Vital status of pre-ART and ART patients defaulting from care in rural Malawi. Tropical Medicine & International Health, 15: 55–62. doi: 10.1111/j.1365-3156.2010.02504.x
- Issue published online: 29 APR 2010
- Article first published online: 29 APR 2010
- antiretroviral therapy;
- patient dropouts;
- sub-Saharan Africa
Objectives To ascertain the outcome of pre-Antiretroviral therapy (ART) and ART patients defaulting from care and investigate reasons for defaulting.
Methods Patients defaulting from HIV care in Chiradzulu between July 2004 and September 2007 were traced at last known home address. Deaths and moves were recorded, and patients found alive were interviewed. Defaulting was defined as missed last appointment by more than 1 month among patients of unknown vital status.
Results A total of 1637 individuals were traced (54%–88% of eligible), 981 pre-ART and 656 ART patients. Of 694 pre-ART patients found, 49% had died (51% of adults and 38% of children), a median of 47 days after defaulting, and 14% had moved away. Of 451 ART patients found, 54% had died (54% of adults and 50% of children), a median of 52 days after defaulting, and 20% had moved away. Overall, 221 patients were interviewed (90% of those found alive), 42% had worked outside the district in the previous year; 49% of pre-ART and 19% of ART patients had not disclosed their HIV status to other household members. Main reasons for defaulting were stigma (43%), care dissatisfaction (34%), improved health (28%) and for ART discontinuation, poor understanding of disease or treatment (56%) and drug side effects (42%).
Conclusion This study in a rural African HIV programme reveals the dynamics related to health service access and use, and it provides information to correct programme mortality estimates for adults and children.