Contrasting Reasons for Discontinuation of Antiretroviral Therapy in Workplace and Public-Sector HIV Programs in South Africa
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Date
2011-01Author
Dahab, M.
Kielmann, Karina
Charalambous, S.
Karstaedt, A.
Hamilton, R.
La Grange, L.
Fielding, K.
Churchyard, G.
Grant, A.
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Dahab, M., Kielmann, K., Charalambous, S., Karstaedt, A., Hamilton, R., La Grange, L., Fielding, K., Churchyard, G. & Grant, A. (2011) Contrasting Reasons for Discontinuation of Antiretroviral Therapy in Workplace and Public-Sector HIV Programs in South Africa, AIDS Patient Care and STDs, vol. 25, , pp. 53-59,
Abstract
We investigated reasons for clinical follow-up and treatment discontinuation among HIV-infected individuals
receiving antiretroviral therapy (ART) in a public-sector clinic and in a workplace clinic in South Africa. Participants
in a larger cohort study who had discontinued clinical care by the seventh month of treatment were traced
using previously provided locator information. Those located were administered a semistructured questionnaire
regarding reasons for discontinuing clinical follow-up. Participants who had discontinued antiretroviral therapy
were invited to participate in further in-depth qualitative interviews. Fifty-one of 144 (35.4%) in the workplace
cohort had discontinued clinical follow-up by the seventh month of treatment. The median age of those who
discontinued follow-up was 46 years and median educational level was five years. By contrast, only 16.5% (44/
267) of the public-sector cohort had discontinued follow-up. Among them the median age was 37.5 years and
median education was 11 years. Qualitative interviews were conducted with 17 workplace participants and 10
public-sector participants. The main reasons for attrition in the workplace were uncertainty about own HIV status
and above the value of ART, poor patient-provider relationships and workplace discrimination. In the public
sector, these were moving away and having no money for clinic transport. In the workplace, efforts to minimize
the time between testing and treatment initiation should be balanced with the need to provide adequate baseline
counseling taking into account existing concepts about HIV and ART. In the public sector, earlier diagnosis and
ART initiation may help to reduce early mortality, while links to government grants may reduce attrition.