Factors Associated with Treatment Default Among HIV Patients Initiating Treatment at Two Selected Hospitals in the Bono Region, Ghana.

Abstract

The introduction of antiretroviral treatment (ART) has transformed HIV/AIDS into a chronic disease, and proven to be the surest intervention to improve the morbidity and mortality associated with HIV/AIDS. Ongoing involvement in care and, importantly, sustained adherence to ART is essential to achieve the 95-95-95 targets for the eradication of HIV. While ART services have been effectively implemented in Ghana, defaulting on HIV treatment is a major setback towards the eradication of the pandemic. This study aimed to assess factors associated with HIV treatment default at Sunyani Municipal and Regional hospitals in the Bono region of Ghana. An analytical cross-sectional study was conducted at the Sunyani Municipal and Regional Hospitals. The study population included all persons diagnosed with HIV and receiving ART services at the HIV clinics at the Regional and Municipal Hospitals in Sunyani. A simple random sampling technique was employed to select 385 patients receiving ART services, and probability proportional to size (PPS) to determine the number of participants from the two selected hospitals. Structured questionnaires were used to collect primary data from patients accessing ART services and the quantitative data was analyzed using multiple logistic regression analysis in Microsoft Excel and Stata Version 17. The study found defaulter rate of 21.7%, and side effects of ARVs were strongly associated with HIV treatment default [X2: 84.82: P=0.000], The fear of rejection from friends was 20.79 times more likely to default on treatment [X2:20.79: p=0.000], whiles missing appointments due to lack of money were more likely to default on treatment [X2: 84.79: p=0.000]. Stigma and discrimination by healthcare professionals were 22.06 times more likely to contribute to default on treatment [X2: 22.06: p=0.000]. Travel time to HIV clinic, mode of transportation, and logistical challenges in accessing care, stigma and discrimination are critical barriers to treatment adherence. The study indicates the interplay of complex factors at multiple levels contributing to ART default and as such no particular factor is statistically significant to cause treatment default. The study recommends that the MOH, GHS, and development partners in the HIV enterprise adopt holistic initiatives targeting individual patients, community, and structural barriers to ART default. The Sunyani Municipal, Teaching hospitals, and the health directorate should introduce comprehensive protocols for managing side effects to address the discomfort of patients, implement mobile clinics, leverage digital tools for appointment reminders, and train healthcare workers on ethically responsive care to mitigate HIV treatment outcomes. This study contributes to the existing literature helping to understand better the HIV menace and influence decisions on program design to improve treatment adherence in the Sunyani Municipality and other settings with similar contexts.