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Concept Note
Title: A Quantitative Study of Factors Associated with Lost to
Follow-Up in Antiretroviral Therapy: Implications for Public Health
Submitted by: Ayana Yadechu, BSc Nurse
Organization: Submitted to AHMC
Date: October 23, 2024
1. Introduction
Antiretroviral therapy (ART) has fundamentally transformed the landscape of HIV management, enabling individuals living with the virus to experience improved health outcomes and enhanced quality of life. Despite these advancements, a significant challenge persists: a considerable number of patients are lost to follow-up (LFU) shortly after commencing ART. This disengagement not only jeopardizes individual health but also presents formidable challenges to public health efforts aimed at controlling the HIV epidemic. LFU can lead to increased morbidity among patients and contributes to the ongoing transmission of the virus within communities. Therefore, it is essential to delve into the multifaceted factors that influence LFU, with the objective of developing effective strategies to improve patient retention in care.
2. Background The complexities surrounding LFU in ART programs stem from a combination of individual, social, and systemic elements. Research has shown that LFU poses significant risks, including the exacerbation of health disparities and the potential for further viral transmission. Understanding the dynamics of LFU is crucial for formulating public health interventions that enhance patient engagement and optimize ART program effectiveness. Prior studies have identified several key determinants of LFU, including demographic characteristics, psychological factors, and systemic barriers to healthcare access.
3. Objectives of the Study
This study aims to:
- Identify and analyze the demographic, psychological, and healthcare system-related factors contributing to LFU among patients receiving ART.
- Explore the interactions between these factors to provide a comprehensive understanding of the determinants of LFU.
- Generate evidence-based recommendations to inform public health strategies aimed at enhancing
patient retention in ART programs.
4. Literature Review A review of existing literature reveals critical insights into the factors associated with LFU in ART settings:
- Demographic Factors: Research consistently indicates that younger individuals and those from lower socioeconomic backgrounds are more likely to experience LFU. Key demographic variables, such as age, gender, and income level, significantly influence adherence to ART regimens, with marginalized populations often facing additional obstacles to consistent care.
- Psychological Factors: Mental health issues, including depression and anxiety, have been identified as significant predictors of LFU. Patients grappling with psychological distress may find it challenging to maintain adherence to treatment protocols and attend regular appointments. Moreover, substance abuse can further complicate these issues, leading to disengagement from care. The presence of social support is also crucial; individuals with strong support networks tend to remain more engaged in their treatment.
- Healthcare System Factors: Systemic barriers to healthcare access, such as long travel distances to facilities, inadequate transportation options, and inconvenient clinic hours, are major contributors to LFU. Additionally, the quality of patient-provider interactions significantly impacts retention rates; supportive and empathetic healthcare environments can foster greater patient engagement.
Despite the wealth of research, notable gaps remain in understanding the intricate interplay of these factors across diverse populations and settings. Much of the existing literature focuses on specific demographic groups or geographic regions, highlighting the need for comprehensive data that captures the varied experiences of all ART patients.
5. Methodology This study will utilize a quantitative, cross-sectional research design, employing structured surveys to collect data from patients currently receiving ART at a range of healthcare facilities. The sample will be purposefully selected to ensure diverse demographic representation. Key variables to be assessed include:
- Psychological Assessments: Standardized instruments for measuring levels of depression (e.g.,
Beck Depression Inventory), anxiety (e.g., Generalized Anxiety Disorder 7-item scale), and substance use (e.g., Alcohol Use Disorders Identification Test).
- Healthcare Access: Evaluation of barriers such as distance to healthcare facilities and availability of transportation.
- Patient-Provider Interaction Quality: Measured through validated satisfaction surveys (e.g.,
Patient Satisfaction Questionnaire).
Data analysis will employ multivariate statistical methods to identify significant predictors of LFU, utilizing software such as SPSS or R to ensure rigorous analysis.
6. Expected Outcomes
The anticipated outcomes of this study include:
- A comprehensive understanding of the multifactorial nature of LFU in ART programs.
- Identification of high-risk groups and specific barriers to care.
- Evidence-based recommendations for public health interventions that aim to improve patient retention, such as tailored outreach programs and policy reforms to enhance healthcare accessibility.
7. Significance of the Study
The findings of this study will significantly contribute to the existing body of knowledge regarding LFU in ART, offering insights that can shape public health strategies and clinical practices. By addressing the underlying factors associated with LFU, healthcare providers and policymakers can develop targeted interventions that enhance patient engagement and retention. Ultimately, these efforts will lead to improved health outcomes for individuals living with HIV and a reduction in transmission rates within communities.
8. References
1. Avert. (2021). HIV and AIDS in the United States of America . Retrieved from https://www.avert.org/professionals/hiv-around-world/united-states
2. Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Beck Depression Inventory-II . San Antonio, TX: Psychological Corporation.
3. Geng, E. H., et al. (2016). "Lost to follow-up among HIV-infected patients on antiretroviral therapy in a resource-limited setting: A systematic review." Journal of Acquired Immune Deficiency Syndromes , 73(2), e20-e28.
4. Kahn, J. G., et al. (2014). "The cost-effectiveness of HIV prevention and treatment in the United States: A systematic review." American Journal of Public Health , 104(8), e1-e14.
5. Spire, B., et al. (2018). "Understanding patient retention in HIV care: A qualitative study." AIDS Care , 30(1), 50-56.
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