Antiretroviral treatments abandon determinants in HIV positive patients, Chiúre, Mozambique, 2015.

Abstract

Background and objective: Mozambique ranks fifth in the world in terms of human immunodeficiency virus incidence rate. In June 2014, 19,256 people were diagnosed with the virus in Chiúre district, Cabo Delgado province and antiretroviral therapy abandon was high. Health education activities were implemented by the District Health, Women and Social Welfare Services and non-governmental organizations such as the Wiwanana Foundation that has been active in the district for two years in the community health program. This study evaluates social, demographic and health determinants associated with antiretroviral therapy abandons proposing solutions to improve adherence.

Methods: multicentre cross-sectional, mixed descriptive study. Patients with HIV who abandoned antiretroviral therapy, technicians involved in consultation and psychological counselling and traditional health practitioners, were interviewed in three health units (Chiúre, Old Chiúre, Ocua) and clinical files were reviewed. The research protocol was approved by Lúrio University Institutional Committee of Health Bioethics and authorized by Cabo Delgado Provincial Health Directorate.

Results:  a total of 149 clinical files were analyzed, 51% female. Mean age was 35 years and 56 % of patients had the primary level of schooling; half of this population is engaged in subsistence agriculture; informal union is the family model for 46% of subjects and non-governmental organizations were more efficient in guiding patients for diagnosis (64%). Disease conditions leading to abandon were the low number of CD4 T lymphocytes and the advanced stage of the disease. The lack of a confidant occurred in 100 % of Chiúre patients, 80 % in Ocua and 50 % in Old Chiúre.

Discussion: ART abandon determinants referred in the literature are confirmed in our research (illiteracy, poor social network, HIV stigma, scarce economic resources, alcohol consumption, difficult access to health services, low quality of clinical management). ART protocol recommends starting treatment when patients present a confidant and the lack of confidant in our study group seems to be a major determinant to ART abandon.

Conclusion: health service deficiencies, the precariousness of the social network and low economic status lead to antiretroviral therapy abandon. The former impair clinical factors: body mass index, CD4 T lymphocyte level, disease stage and occurrence of opportunistic infections; health professionals’ poor collaboration in consultation affected the diagnostic and therapeutic orientation, with a long time between diagnosis and therapy initiation. Lack of family support results in loss of trust among patients and cohabitants, self-exclusion and absence of confidant. Scarce economic resources limit food, education, information and travel, important elements for good adherence to antiretroviral therapy.