Introduction: HIV and AIDS continues to be a major public health challenge for
Zambia, which has the highest HIV prevalence rate of 13.1% in sub-Saharan Africa.
Although individuals living with HIV/AIDS in Zambia have increased access to
antiretroviral treatment (ART), not all patients who are initiated on antiretroviral
treatment remain in care; with some patients being lost at different points in the
continuum of care. The current study aimed to explore the factors affecting retention in
care among patients receiving antiretroviral treatment at three primary health facilities in
the Kabwe district in Zambia.
Methodology: An exploratory qualitative study design was used to explore the patient,
health systems and socio-economic factors that underlie retention on ART in three
purposefully selected primary health care facilities in Kabwe district. Data was collected
through in-depth interviews with 45 ART patients and three focus group discussions with
20 health care providers. The content of the transcribed interviews was analyzed
thematically.
Findings: The overall retention rate of the ART sites was found to be 65%. The main
patient factors that influenced retention in care were side effects of antiretroviral drugs
and weight increase as a sign of good health. The social related factors that influenced
patient retention in care were stigma and non-disclosure of HIV status, faith healing, use
of herbal remedies and alcohol use. The health system factors that contributed to poor
retention of patients in care were long waiting times due to staff shortage, high patient
load, travel distance to ART centers and transportation cost. Other health system factors
reported by participants included shortage of third line ARV drugs and inadequate space
in ART clinic. Finally, food shortage and mobility of patients due to employment were
some of the identified economic factors that influenced patient retention in care.
Conclusions: A large proportion of adult patients initiating ART in Zambia are poorly
retained in care because of patient, health system, social and economic factors. In order to
improve retention, more nurses and clinical officers should be trained in ART
management to improve skills and address staff shortages. It would also be useful for
iii
Zambia to introduce community drug distribution points for delivering ARV refills to
reduce the workload on the existing ART sites and reduce on the distances that patients
have to travel to ART centers. Additionally, efforts should also be made to improve ART
care by extending ART clinic days to include all the days of the week except Sundays.