Barriers to sustaining antiretroviral treatment in Kisesa, Tanzania: a follow-up study to understand attrition from the antiretroviral program.
Two years after the introduction of free antiretroviral therapy (ART) in Tanzania and in spite of the logistical support provided to facilitate clinic attendance, a considerable level of attrition from the program was identified among clients from a semi-rural ward. Qualitative research on ART patients' health-seeking behavior identified factors affecting sustained attendance at treatment clinics. A mix of methods was used for data collection including semi-structured interviews with 42 clients and 11 service providers and 4 participatory group activities conducted with members of a post-test group between October and December 2006. A socio-ecological framework guided data analysis to categorize facilitators and barriers into individual, social, programmatic, and structural level influences, and subsequently explored their interaction and relative significance in shaping ART clients' behavior. Our findings suggest that personal motivation and self-efficacy contribute to program retention, and are affected by other individual-level experiences such as perceived health benefits or disease severity. However, these determinants are influenced by others' opinions and beliefs in the community, and constrained by programmatic and structural barriers. Individuals can develop the requisite willingness to sustain strict treatment requirements in a challenging context, but are more likely to do so within supportive family and community environments. Effectiveness and sustainability of ART roll-out could be strengthened by strategic intervention at different levels, with particular attention to community-level factors such as social networks' influence and support.
Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, University of London, Mwanza, Tanzania. maria.roura@lshtm.ac.uk
Maria
M
Roura
Joanna
J
Busza
Alison
A
Wringe
Doris
D
Mbata
Mark
M
Urassa
Basia
B
Zaba
D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D003466:Cultural Characteristics; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D009042:Motivation; D010342:Patient Acceptance of Health Care; D010349:Patient Compliance; D011584:Psychology; D020377:Self Efficacy; D013636:Tanzania / Q000453:epidemiology
D019380:Anti-HIV Agents