An investigation of the factors associated with default of scheduled drug pick-ups and clinic visits by patients on antiretroviral therapy at Murchison Hospital, Kwa Zulu Natal Province in South Africa
Thesis (MPhil (Industrial Psychology))--University of Stellenbosch, 2009.
The fact that patients on Highly Active Antiretroviral Therapy (HAART) default scheduled drug pick-ups and clinic visits requires attention, because the long-term effect is non-adherence to prescribed regimens and the development of drug resistance, as indicated in the report of the Fourteenth Conference on Retroviruses and Opportunistic Infections held in November 2007 in Los Angeles. A cross-sectional survey and observational qualitative study was done to identify key factors associated with the fact that patients on antiretroviral therapy fail to pick up drugs and keep scheduled clinic appointments, with a view to suggesting intervention measures. The study focused on Murchison Hospital in Ugu District, Kwa Zulu Natal Province. Data were collected from patient records, telephonic interviews with patients, or patients’ caregivers, treatment supporters and family members of a patient who did not return for follow-up at the clinic, as well as from face-to-face interviews with healthcare workers to understand the reason for default. Observation checklists were used to collect data from systems, structures and processes used in services provision. Thereafter data were analyzed through the various stages of coding and writing up of notes and reported. Of 638 defaulters identified, 205 were contactable, and only 95 patients were reached. The key factors associated with default identified were death (49.5%) and logistics and cost (15%). Other additional factors were travel and migration, religious beliefs, hospitalization, side effects, work schedules and commitments, imprisonment and visiting private practices. Poor relationships with healthcare workers, patients’ financial difficulties and termination of disability grants added to the problem.