Factors associated with defaulting among women initiated on option B+ in urban clinics- 2015

Abstract

Introduction: We carried out this study to describe the demographic characteristics of the mothers on Option B+ at Budiriro, Mabvuku, Rutsanana and Kuwadzana poly-clinics. To determine the patient level factors, the service related factors, the provider-patient relationship factors, the environmental, socio- cultural factors and the drug related factors associated with defaulting among women initiated on Option B+ at the four poly-clinics, 2015. Methods: A 1:2 unmatched case control study was conducted. A total of 195 participants were recruited, 65 cases and 130 controls. The study was carried out at four polyclinics, Rutsanana, Mabvuku, Kuwadzana and Budiriro. Simple random sampling technique was used to select study participants from the Option B+ registers. A case was an HIV positive pregnant or lactating woman registered and initiated for Option B+ at any one of the four sites from January to April 2015 but missed at least one resupply visit or medicine pick up appointment for ART. A control was an HIV positive pregnant or lactating woman registered and initiated on Option B+ at any one of the four sites from January to April 2015 and attended all resupply visits or medicine pick up appointments for ART. Data were collected using interviewer administered questionnaires, in depth interviews, focus group discussions and key informant interviews. Quantitative data were analysed using Epi infoTM 7 to generate tables and graphs. Qualitative data were analysed manually using themes. The median age for cases was 27 years (Q1 = 23.5, Q3 = 32 years) while that of controls was 30 years (Q1 = 26.5, Q3 = 35.5 years). Results: Non-disclosure of HIV status and having experienced stigma because of HIV status were significant patient level factors that were associated with defaulting with OR 16.6 and 14.3 respectively, (p<0.05). Running short of medication at some point and having experienced drug side effects were significant drug related factors associated with defaulting with OR 52 and 4.0 respectively, (p<0.05). Receiving inadequate information during counselling and not having attended individual counselling sessions were significant service related factors associated with defaulting with OR 9.4 and 3.7 respectively, (p<0.05). Conclusions: Factors associated with defaulting among women initiated on Option B+ vary. Some of the factors have to do with the patient while some are related to the service that they receive and their relationship with the health care provider. Some are however related to the availability and the effects of the drugs themselves. We recommend providing adequate information on all the factors that might affect the women, encouraging disclosure of status so that they get support from others and strengthening of follow up mechanisms.