Antiretroviral treatment default and associated factors among people living with HIV/AIDS in Ayder Referral Hospital, Tigray, Ethiopia

Introduction
Antiretroviral therapy has turned HIV/acquired immunodeficiency syndrome (AIDS) from lethal to manageable chronic disease. However, treatment defaulting is a prominent challenge in development of drug resistance and eventually, leads to treatment failure. The aim of this study was to assess the prevalence of defaulting and associated factors among people living with HIV/AIDS (PLWHA) in the Ayder Referral Hospital, Tigray.

Material and methods
Defaulters were individuals who failed to take medication two or more doses in a single clinical appointment. Retrospective cohort study was employed to obtain socio-demographic data and the status of ART use among PLWHA in the study hospital. Semi-structured interview was conducted to obtain data on factors associated with defaulting treatment. In-depth focused group discussion was done with those who attended subsequent conversations made at the hospital. Telephone call was performed to those who were reluctant to attend the discussions.

Results
Data were presented using simple descriptive statistics. Of 240 patients who initiated ART, 160 (66.6%) were active users and 80 (34%) had missed more than one clinical appointment. Out of those 80, 58 (24.16%) were defaulters and 22 (9.16%) died. Self-referral to other hospital, lack of food, social stigma, spiritual healing, and loss of interest in medication were the commonest reasons for defaulting ART medication. Tracing was not successful due to incorrect address at the register in 12 (21%) of the defaulters.

Conclusions
Socio-economic factors appear to be the root of all reasons associated with ART default. ART clinic staffs should make sure that the address given at the register is genuine to facilitate adherence assessment.