Factors associated with missed appointments among adults on anti-retroviral therapy in the uThukela District in Kwazulu-Natal, South Africa

Abstract

Introduction: High rates of missed clinic appointments among adults on Anti-Retroviral Therapy (ART) in KwaZulu-Natal pose a great threat to the success of the ART programme in South Africa. This is seen in the number of missed appointments reported by the Three Interlinked Electronic Registers system. Missed appointments predict poor adherence to ART and are associated with sub-optimal clinical outcomes. Demographic, patient-related, health systems and socio-cultural related factors reportedly contribute to missed appointments. Purpose: This study aimed to determine the factors associated with missed appointments among adults on Anti-Retroviral Therapy in the uThukela District of KwaZulu-Natal. Methods: A comparative descriptive study using a cross-sectional survey was conducted. Using the convenience sampling technique, 104 adults on ART (missed appointment group = 52, adherent group = 52) were recruited for the study. Data were collected using a structured and validated survey questionnaire. Statistical Package for the Social Sciences (SPSS) version 20 was used for data analysis. Descriptive statistics such as frequencies were used to summarise the results. Inferential statistics namely, Chi-square, Mann-Whitney and Fisher’s exact tests, were used to compare the responses between the groups. Principles of beneficence, respect for human, confidentiality and voluntary participation were maintained. Results: Three (n=3) demographic, seven (n=7) patient-related and eight (n=8) health-related factors were significantly associated with missed appointments (p<0.05). The factors are gender, employment status, HIV status disclosure, stigma, discrimination or isolation, lack of adequate nutrition, side effects of ARVs, mistreatment by the clinic staff, lack of counselling regarding ARVs, use of traditional medicine, lack of transport or transport fare, unacceptable facility setting, unacceptable rendering of HIV services, lack of nutritional support, inadequately prepared clinic staff, lack of comprehensive HIV care package, staff attitudes, dissatisfaction with the quality of services and being turned back without receiving health care services. Conclusion and Recommendations: The results identified factors that contributed to missed ART appointments. The results are expected to contribute to the existing body of knowledge on missed appointments. Recommendations for further research, patient care, staff training and strengthened stakeholder engagement have been provided to address ART missed appointments in this region.