Characterisation of Treatment Interruptions at Mpilo HIV Centre of Excellence, Bulawayo Province, Zimbabwe, 2020-2021

Abstract

Non-adherence to Antiretroviral Therapy treatment is a growing concern in ART programs and is causing significant adverse outcomes amongst People Living with HIV (PLHIV). Whilst significant strides have been made in terms of HIV epidemic control with the introduction, roll-out and scaling up of ART in the public sector and more recently emphasis on retention in care, non-adherence, including missed doses, missed appointments and treatment interruption are posing a significant threat to the success of ART programs. Treatment interruptions amongst the cohort of PLHIV in care at Mpilo Centre of Excellence (CoE) has not been investigated, and as such, not much is known about the characteristics and factors associated with treatment interruption within this group. This study sought to understand the demographic and clinical characteristics of treatment interrupters, the timing, frequency and duration of treatment interruption spells as well as determine the themes associated with treatment interruption amongst the cohort of Recipients of Care (ROC) at Mpilo CoE. A case study research design using mixed methods research approach was conducted on ROC at Mpilo CoE using data from electronic medical records and interviews with research participants using a modified Adherence Barriers Questionnaire. Adults aged between 20 and 49 are most liable to treatment interruption with this age group making up 64.0% of treatment interrupters. 40% of patients interrupting treatment at Mpilo Centre of Excellence initiated ART after 2015, with 22.1% initiating between 2011 and 2015 and 28.4% initiating between 2006 and 2010. There is a correlation between frequency of treatment interruption and duration of treatment interruption with a p-value of 0.010 and correlation coefficient of -0.152. The two most significant of the responses to reasons for treatment interruption were psychological reasons (27.5%) and geographical reasons (17.4%). Sociological reasons and financial/economic/political reasons accounted for 14.7% and 11.9% of respectively. Chi-square test was conducted the 9 themes and 24 subthemes linked to treatment interruption using Likelihood Ratio’s. Two subthemes under Technological themes are significantly associated with treatment interruption; poorly documented treatment records with moderate association (Cramer’s V = 0.228) and usefulness of SMS reminders with a relatively strong association (V = 0.454). High number of clinic visits has moderate association with treatment interruption (V = 0.264) and is the only sub-theme under Technical and Service Provision linked theme with a significant association with treatment interruption. The results of the study will assist Mpilo COE managers and other policy makers to restructure patient care so as to offer a holistic approach to HIV management thereby improving client retention .In conclusion treatment interruption characteristics vary across different demographic groups, which indicates that for these different demographic groups, factors and themes associated have varying influence, and as such, interventions and strategies to counter treatment interruption should be tailor made for each sub group in order to be effective.