title: Vital status of pre-ART and ART patients defaulting from care in rural Malawi.
abstract: OBJECTIVE
  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%).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Médecins Sans Frontières, Chiradzulu, Malawi.
authors.forename: Megan
authors.initials: M
authors.lastname: McGuire
authors.forename: Tamika
authors.initials: T
authors.lastname: Munyenyembe
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Szumilin
authors.forename: Annette
authors.initials: A
authors.lastname: Heinzelmann
authors.forename: Mickael
authors.initials: M
authors.lastname: Le Paih
authors.forename: Nenette
authors.initials: N
authors.lastname: Bouithy
authors.forename: Mar
authors.initials: M
authors.lastname: Pujades-Rodríguez
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000523:psychology / Q000706:statistics & numerical data*; D001294:Attitude to Health; D018791:CD4 Lymphocyte Count; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D008295:Malawi / Q000453:epidemiology; D008297:Male; D010352:Patient Dropouts / Q000523:psychology / Q000706:statistics & numerical data; D012423:Rural Health / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D055815:Young Adult; D016903:Drug Monitoring