Why adult patients on antiretroviral therapy miss clinical appointments in rural villages of Limpopo Province, South Africa: An exploratory study

Abstract

Background: Missing clinical appointments while on antiretroviral therapy (ART) is associated with poor adherence to treatment and an increased risk of poor immunological outcomes. Aim: This study explored the reasons why adults missed clinical ART appointments. Setting: The study was conducted in community healthcare centres (CHCs) with high rates of missed appointments by ART patients. Methods: An explorative qualitative research design was used for this study. The population comprised all adult patients on ART who had missed their clinic appointments. The simple random sampling method was used to select sample healthcare centres with high absenteeism from the district health information system. Furthermore, a purposive systematic sampling technique was used to sample ART patients who had missed more than two appointments in a year. Thirty-seven patients were interviewed, as determined by data redundancy, using in-depth individual unstructured interviews, as guided by the following central question: ‘How is it for you to miss your clinic appointments?’ Tesch’s eight steps were used to analyse the data. Results: Participants cited a lack of family support, financial constraints, nondisclosure of HIV status at the workplace and a lack of patient involvement in scheduling appointments as reasons for nonadherence to ART appointments. Conclusion: Missed appointments disrupt the functionality of healthcare systems and negatively impact the quality of patient’s care. Patients missing appointment are likely to interrupt HIV care and run a risk of clinical and immunological failure. Contribution: This study contributes to knowledge as to why patients on ART miss appointments. It will also provide practical guidance to come up with a strategy that will reduce missing appointments and to improve adherence to treatment and health outcomes of patients on ART.