Defaulting from treatment remains a challenge for most HIV/AIDS control
programmes. It may increase the risk of drug resistance, prolonged infection or
death. The aim of this study was to explore and describe factors that contributed to
patients defaulting in taking Highly Active Anti-Retroviral Therapy (HAART) in
Oshakati and to propose appropriate interventions. The method used in the study
was a combined quantitative and qualitative approach (mixed method). A cohort of
patients who defaulted in their HAART treatment in Oshakati as at the end of July
2007 was identified using the pharmacy ART dispensing tool that could generate a
list of defaulters for that month. In the quantitative phase a structured questionnaire
with potential predictor factors drawn from literature review was administered to 76
(95.0 %) of 80 defaulters who were successfully traced. In the qualitative phase, a
focus group discussion comprising of 12 defaulters was conducted.
The reasons for defaulting were unclear in the quantitative phase of the study.
During the focus group discussion of the qualitative study, reasons given by
informants were complex and included the treatment process, poor patient-provider
relationships ultimately leading to dissatisfaction with services provided, financial
constraints to pay for food and transport, the long distance between the facility and
place of residence, lack of accurate information about the treatment and its outcome,
illiteracy, lack of psychosocial support, lack of immediate beneficial effects and/or
harmful effects after initiating on treatment. The default rate in this study was
ii
relatively low compared to other studies. ART facilities should ensure that patients’
addresses are complete and correct.
It was recommended that efforts aimed at increasing literacy and reduction in stigma
and discrimination should be targeted towards both the patients and the community,
ART services should be decentralised and, where possible, home based treatment
care, instituted where adherence levels can be ascertained.