“Exploratory analysis of the facility-level factors associated with HAART abandonment in central Mozambique

BACKGROUND AND IMPLEMENTATION APPROACH: Enhanced long-term patient adherence to antiretroviral therapy is critical for the success of rapidly expanding treatment programs. The objective of our study was to explore the health system factors related to HIV treatment abandonment and investigate the causes of variation in abandonment rates across treatment sites in central Mozambican. ANALYSIS DESIGN AND METHODS: We selected four HAART sites exhibiting high rates of patient abandonment and matched them with a comparable set of four clinics alternatively demonstrating low rates of abandonment. At each site, in-depth interviews, focus groups and direct observation sessions were conducted to identify key themes facilitating and impeding long-term adherence as well as to theorize about the origin of the differential rates of treatment abandonment in the region. RESULTS: General patient dissatisfaction exists with respect to pharmacy waiting times and protocols throughout the region. In particular, due to MOH efforts to integrate the pharmacy services for HIV and non-HIV patients, respondents complained of the lack of privacy when picking up prescriptions.Transport to the clinics is a commonly expressed barrier; numerous patients complain about the scarcity of transport subsidies that they claimed helped mitigate the cost of accessing care. Lack of food is an important factor for abandoning treatment; the existence of reliable food supplement programs was consistently mentioned as a key facilitator to treatment maintenance. However, many respondents also expressed disillusion upon realizing their vouchers expired after three months time. CONCLUSIONS AND RECOMMENDATIONS: Systematic correction of flow bottlenecks may result in greater user satisfaction and patient retention. Multi-sector coordination efforts and a stronger planning and management team are needed within regional health offices to respond to food security, logistics, and hospital design.