MPH, Faculty of Health Sciences, University of the Witwatersrand, 2009. / Introduction
Patient retention and loss to follow-up in the antiretroviral programmes in South
Africa and indeed the world is important as failures to reduce these lead to higher
drug resistances and treatment failures. In the light of the few drugs available to treat
HIV and AIDS it is imperative that patients lost to follow-up be traced and brought
back into the programme. The objectives of the study were to quantify the number of
patients enrolled in the programme between 01st June 2004 and 31st December 2004;
determine the demographic profile of enrolled patients with regard to age; sex;
education; employment and area of residence; to determine compliance and defaulter
rates at every monthly appointment up to 6 months of follow-up and to describe
follow-up systems in place for tracking patients on ARVs; identifying those who fail
to comply with scheduled appointments; and ensuring complianceand finally to
identify challenges faced by the hospitals in tracking patients on ARV therapy.
Material and Methods
The two hospital chosen were the first public hospitals to rollout antiretroviral
treatment in Ekurhuleni in 2004. This was a descriptive study involving review of
health facility records and primary data collection through key informant interviews at
two district hospitals in Ekurhuleni. The study reviewed mechanisms employed by the
two hospitals in tracking those patients who started on the programme during the first
six months of the ARV programme (June 2004 to December 2004).
Results
The two hospitals had after six months of starting with the rollout a combined number
of 378 patients on treatment. Far East Rand Hospital (FERH) had registered 208
5
patients and Natalspruit (NSH) had 170 patients on their register. Most of the patients
started on treatment were from Townships (82%), and 81% of all patients started on
treatment were unemployed. The male(33.7%) to female (62.7) ratio was 1:2. Even
though on average 90% of patients at both hospitals kept their first six appointment,
defaulter rates at FERH was 23,2% and NSH was sitting at 33,1%.
Discussion
Our results show tha the two hospitals fall short on achieving the requierements by
the Departmentof Health’s HIV plan that states under Priority Area 2, point 6.2, that
accredited facilities must have the capacity to increase the retention of children and
adults on ART – actively trace people on ART who are more than a month late for
clinic/pharmacy appointment. The hospitals do not have proper tracking mechanisms
in place, they lack important resources like transport, telephones and get wrong
addresses. Based on the evidence we have gathered the hospitals’ defaulter rates and
loss to follow-up are a concern but they are also not far off when compared to other
places and countries whose defaulter rates are 20% on average.
Conclusion and Recommendation
Retention of patients in the programmes is an essential health imperative. It is
therefore necessary that we make the following improvements to our hospital
programmes: Make resources like telephone and transport available to healthcare
workers; employ a dedicated team of workers doing only patient tracing and followup;
invest in technology that would alert health care workers immediately a patient
misses an appointment and finally educate the patients themselves of the importance
of adherence to treatment and follow-up.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:wits/oai:wiredspace.wits.ac.za:10539/7654 |
| Date | 10 March 2010 |
| Creators | Ncholo, Emmanuel Kgotso |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | application/pdf |
Page generated in 0.0023 seconds