Cluster | Statements |
---|---|
Poor documentation | Poor filing means that patient files can get lost when patients on ART are being transferred |
The patient has died but their death is not reported | |
Patients have little social support in the villages due to lack of counsellors, support groups and community-based organizations | |
The patient has moved away to another clinic without being properly transferred | |
Patient visits are not being recorded accurately | |
Resources needed for effective tracing | Tracing starts too late because of the way a ‘defaulter’ is defined (e.g., missing an appointment by 2 months or more) |
The HSAs have difficulty locating patients because they do not live in their catchment areas and therefore do not know the villages where people come from | |
Patients on ART can’t be found if the HSAs do not have their proper address and/or their locator forms | |
They live in areas that are difficult to reach so that the HSAs have difficulty tracing them | |
Health workers have difficulty locating patients without working phones or phone numbers | |
There is no fuel or dedicated transport for tracing | |
Social and financial support issues | Being too sick to come to the clinic |
The distance to the clinic is too far from some patients on ART | |
The guardians of the patient refuse to go the hospital to collect their ARVs from them | |
Patients on ART can’t afford transport means to come to the clinic because they face poverty | |
A lack of support for ART patients especially when they are orphans | |
Patients on ARV medicines may also have to deal with other diseases such as chronic illness | |
Patients on ARV medicines feel hungry but they can’t afford to buy extra food | |
They are attending to another sick relative (e.g., child) | |
Health worker attitudes | Patients are on ART feel that there is a lack of confidentiality on behalf of the health workers (e.g., drugs given without privacy) |
Patients on ART get disappointed when they are not put on a different ART regimen to help manage their side effects | |
Patients are not properly educated on ART because of little one-on-one counselling with the health workers | |
Patients on ART do not like the way they are treated by health workers | |
Patients feel shy to come to the health centre because there is limited space and no privacy | |
Patients on ART get frustrated because it takes too long before they are seen at the hospital | |
Anxiety about going back to the clinic after missing many appointments | |
To hide from follow-up, patients change their names and identities | |
Health worker issues related to tracing | There are too many patients needing to be traced and not enough health workers to trace them |
Poor communication and coordination between the HSA and ART providers | |
There is no coordinator for ART tracing and no specific follow-up health workers | |
There is no training on how to do the follow-up of ART patients | |
The health workers just wait for the patients to come back on their own because their are no consequences for them if they don’t trace them | |
There is no deliberate effort to trace ART patients because there are no incentives for the HSAs | |
The HSAs do not actually trace patients and instead write fake information about patient visits | |
The HSAs don’t value tracing because they have too much other work | |
Stigma and fears | The patient on ART fears stigmatization because they are transferred to a health centre that is near to where they live |
Fear of divorce if their spouse or loved one discover that they are on ART | |
The patient doesn’t want to be associated with ARV drugs because of stigma and fear of isolation | |
Patients on ART experience side effects from the medicine | |
Patients on ART fear side effects and the unknown | |
Patients on ART face mental health issues | |
Patients stop coming to the clinic because they get their ARV drugs from somewhere else | |
Fear dismissal at the work place because their employer may discover that they are on ART | |
Access to ART | Patients have difficulty finding ARVs when they travel both within and outside the country |
ARV medicines are not always accessible because of inconsistent drug availability | |
Not being able to meet strict hospital policies (e.g., coming with a guardian) | |
The patient just picked up a guardian at the market and the guardian cannot be used to trace the patient | |
Patients are mobile and they move around a lot | |
Beliefs | Religion and the belief that prayer, not ARVs, will heal them |
Church fellowships discourage them from taking their ARVs and tell them they are healed from HIV | |
Patients on ART believe that they are HIV negative because they gave birth to a negative baby or re-tested negative for HIV | |
Beliefs in traditional medicines | |
Patients on ART believe that they are healed from HIV if they sleep with a virgin or a younger person | |
Lack of knowledge and acceptance | Patients feel tired of taking their drugs |
Patients on ART don’t see the need to be on drugs anymore when they feel better and their health has improved | |
When there is no improvement in their health, patients on ART are frustrated because they were expecting a quick recovery | |
The patient on ART has not accepted their HIV status | |
Patients on ART want to have a normal life and feel the medicine is a burden | |
Patients on ART are just not serious about their lives | |
Patients see no value in taking their ARVs anymore because they have given up on life | |
Patients find new marriage partners and do not want them to find out that they are on ART | |
Pregnancy and wanting to protect the unborn child from ART | |
Patients prefer alcohol over taking ART | |
Patients have too many lovers and not enough time to take their ARVs |