title: Barriers to retention in care as perceived by persons living with HIV in rural Ethiopia: focus group results and recommended strategies.
abstract: Inability to retain HIV-infected patients in care undermines the benefits of starting millions in low-income countries on antiretroviral therapy (ART). In a hospital HIV clinic in rural southern Ethiopia, we conducted focus groups of HIV-infected men and women to learn more about experiences with and barriers to attending clinic appointments. Respondents reported multiple barriers, including those that were patient related (eg, misunderstandings about ART, mistaken belief in AIDS cures, and drug/alcohol use), clinic related (eg, negative provider interactions, lack of familiarity with patients' medical situation, and overcrowding), medication related (eg, side effects), social (eg, stigma and discrimination and lack of support), and situational/resource related (eg, distance to clinic, lack of funds, competing domestic/work priorities, and lack of food). Based on the lessons learned from these focus groups, we implemented a community intervention to improve retention, using trained community support workers who provide patient education, counseling, social support, problem-solving assistance, needed referrals, and improved communication/linkage to the patients' HIV clinic.
authors.affiliation: Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN 55454, USA. lifso001@umn.edu
authors.forename: Alan R
authors.initials: AR
authors.lastname: Lifson
authors.forename: Workneh
authors.initials: W
authors.lastname: Demissie
authors.forename: Alemayehu
authors.initials: A
authors.lastname: Tadesse
authors.forename: Kassu
authors.initials: K
authors.lastname: Ketema
authors.forename: Randy
authors.initials: R
authors.lastname: May
authors.forename: Bereket
authors.initials: B
authors.lastname: Yakob
authors.forename: Meka
authors.initials: M
authors.lastname: Metekia
authors.forename: Lucy
authors.initials: L
authors.lastname: Slater
authors.forename: Tibebe
authors.initials: T
authors.lastname: Shenie
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000008:administration & dosage / Q000009:adverse effects; D003441:Crowding; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D017144:Focus Groups; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology*; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D055118:Medication Adherence; D010044:Outpatient Clinics, Hospital; D011287:Prejudice; D011369:Professional-Patient Relations; D012424:Rural Population; D057545:Social Stigma; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000453:epidemiology
chemical_list: D044966:Anti-Retroviral Agents