Factors affecting patients on antiretroviral therapy lost to follow-up in Asunafo South District of Ahafo Region, Ghana: a cross-sectional study

• Published in: BMJ Public Health 2024-10, Vol.2 (2), p.e000944
• Main Authors: Kogi, Robert, Krah, Theresa, Asampong, Emmanuel, Kamau, Edward Mberu
• Format: Article
• Language: English
• Subjects: Cross-Sectional Studies; Disease Notification; HIV; Original research; Public Health; Sociodemographic Factors
• ISSN: 2753-4294; 2753-4294
• DOI: 10.1136/bmjph-2024-000944

IntroductionDespite the increased and effective programme coverage for antiretroviral therapy (ART), a considerable proportion of individuals receiving ART discontinue medication at different stages of their treatment pathway. In sub-Saharan Africa, approximately half of individuals who test positive for HIV are lost to follow-up (LTFU). This study was set out to answer the following question ‘What are the factors that affect patients on ART loss to follow-up in Asunafo South District of Ghana?’.MethodsCross-sectional study design with systematic random sampling was employed to select 620 HIV patients on ART. Stata V.17.0 was used to analyse the data. A cox-proportional hazard regression was fitted in order to determine the predictor variables. Variables for the multivariable regression model were chosen by entering the outcome variable (LTFU) and explanatory variables into the model. Finally, the association between the explanatory and outcome factors was determined using the adjusted HRs and their associated 95% CI was considered.ResultsA total of 600 respondents were used for the final analysis after data cleaning. Patients who began ART at age 41 years or older had a significantly lower chance of being LTFU than those who began ART at age 35 or less (adjusted HR (aHR)=0.34, 95% CI 0.13 to 0.84). Furthermore, patients who started ART with a primary education had 1.68-fold increased risk of LTFU compared with patients with no education (aHR=1.68; 95% CI 0.83 to 3.43). In addition, patients in rural locations had a 2.65-fold higher likelihood of being LTFU than patients in urban areas (aHR=2.65, 95% CI 1.29 to 5.44). The main reasons for missing ART appointments among patients included walking long distance to clinic, cost of transportation, fear of scolding from clinic staff, stigma and erratic supply of antiretrovirals.ConclusionAll clinicians should consider the risk factors that have been identified when providing ART services and counselling.