Matimbwa Hassan, Lolo Sarah Andrea, Matoy Leila S, Ndaki Regina, Ngahyoma Suzan, Mollel Henry Abraham, Luoga Ezekiel, Vanobberghen Fiona, Vianney John-Mary, Idindili Boniphance, Weisser Maja
Interventions and Clinical Trials Department, Ifakara Health Institute, Morogoro, Tanzania.
School of Life Science and Bioengineering, The Nelson Mandela African Institute of Science and Technology, Tengeru, Arusha, Tanzania.
HIV AIDS (Auckl). 2025 Feb 4;17:39-57. doi: 10.2147/HIV.S492673. eCollection 2025.
People living with HIV (PLHIV) with good adherence to antiretroviral therapy (ART) achieve good health outcomes. However, treatment interruptions remain a major challenge, particularly in rural Africa. This study explored factors related to dropout, return, retention in care, and treatment adherence among PLHIV returning to care after missing clinical visits.
We conducted an exploratory study using a phenomenological approach in rural South-eastern Tanzania, from July to October 2023. In-depth interviews (IDIs) were conducted with 21 PLHIV who resumed care after missing visits for three months or more from the last scheduled appointment and who were taking ART less than 60 days within the last three months, and their 13 treatment supporters. Interviews were conducted at St. Francis Regional Referral Hospital and Kibaoni Health Center.Five focus group discussions (FGDs) were conducted with 6-8 healthcare workers from Kibaoni, Mang'ula, Mkamba, Mgeta Health Center, and St. Francis Hospital. Data were analyzed by thematic analysis, with NVivo 12 software.
The median age of the 21 PLHIV was 40 years (range 21 to 63); 10 (47.6%) were females. Reasons for dropping out of care reported included fear of disclosure, complacency with improved health, denial of HIV status, work-related absence, and religious beliefs. Reasons for returning included health deterioration, completion of work obligations causing care interruption, family support, and clinic follow up. Factors promoting retention and adherence were improved health through ART, trust in healthcare services, counseling, health education, clinic follow-up, longer drug refill periods, and family support.
Our study highlights persisting stigmatization contributing to dropping from care, with strong family and social support improving adherence and clinic attendance. Future interventions should focus on these factors to enhance retention of lifelong treatment adherence. Working obligations remain a challenge, that could be addressed by facilitated access to remote drug pickup.
坚持接受抗逆转录病毒治疗（ART）的艾滋病毒感染者（PLHIV）能取得良好的健康结果。然而，治疗中断仍然是一个重大挑战，尤其是在非洲农村地区。本研究探讨了错过临床就诊后重新接受治疗的PLHIV中与退出、返回、持续接受治疗及治疗依从性相关的因素。
2023年7月至10月，我们在坦桑尼亚东南部农村地区采用现象学方法进行了一项探索性研究。对21名PLHIV及其13名治疗支持者进行了深入访谈（IDI），这些PLHIV自上次预定就诊起三个月或更长时间未就诊后重新接受治疗，且在过去三个月内接受ART治疗少于60天。访谈在圣弗朗西斯地区转诊医院和基巴奥尼健康中心进行。与来自基巴奥尼、曼古拉、姆坎巴、姆格塔健康中心和圣弗朗西斯医院的6 - 8名医护人员进行了五次焦点小组讨论（FGD）。使用NVivo 12软件通过主题分析对数据进行分析。
21名PLHIV的中位年龄为40岁（范围21至63岁）；10名（47.6%）为女性。报告的退出治疗原因包括害怕被披露、因健康改善而自满、否认感染艾滋病毒状况、与工作相关的缺勤以及宗教信仰。返回治疗的原因包括健康恶化、完成导致治疗中断的工作义务、家庭支持以及诊所随访。促进持续治疗和依从性的因素包括通过ART改善健康、对医疗服务的信任、咨询、健康教育、诊所随访、更长的药物 refill 期以及家庭支持。
我们的研究强调了持续存在的污名化导致退出治疗，强大的家庭和社会支持可提高依从性和诊所就诊率。未来的干预措施应关注这些因素，以提高终身治疗依从性的持续率。工作义务仍然是一个挑战，可通过便利远程取药来解决。
