Loss to Follow-Up among a Group of Patients with HIV and Severe Mental Illness in South Africa

Todd Wagner, Jennifer Furin, Barbara Gripshover, Yasmien Jeenah, Greg Jonsson

Case Western Reserve University School of Medicine, Department of Family Medicine & Community Health, Cleveland, USA.
Case Western Reserve University School of Medicine, Division of Infectious Diseases, Cleveland, USA.
Case Western Reserve University School of Medicine, TB Research Unit, Cleveland, USA.
Department of Psychiatry, University of the Witwatersrand, Johannesburg, South Africa.

DOI: 10.4236/wja.2014.41009                

Abstract

Background: Persons with HIV and severe mental illness face numerous barriers in antiretroviral treatment adherence. More information is needed on reasons for loss of follow-up in this population. Methods: A retrospective analysis was conducted on adult HIV patients with a history of mental illness enrolled at an urban HIV clinic in Johannesburg, South Africa who discontinued care. Results: 24.8% of adult patients in the clinic discontinued follow-up during the study period. Of those discontinuing follow-up, 48 were successfully traced by home visits. Among this group, 21 (43.8%) were not engaged in care, 12 (25.0%) had transferred care, 9 (18.8%) were deceased, 3 (6.2%) had relocated, and 3 (6.2%) were missing. Transportation costs and distance, conflicts with work/school schedule, and confusion regarding when to return were the most frequently cited reasons for discontinuing follow-up. Conclusions: Although almost 25% of patients were lost to follow up, overall rates of retention in care for these patients were similar to those seen in other HIV-infected populations and higher than those seen among patients with psychiatric disease. Tracing patients through home visits proved to be an effective means to confirm the magnitude of patients lost to follow up, ascertain their outcomes, and elucidate the reasons for discontinuing care.

Keywords

HIV; Mental Illness; Loss of Follow-Up; South Africa

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Williams, B.G., Lima, V. and Gouws, E. (2011) Modeling the Impact of Antiretroviral Therapy on the Epidemic of HIV. Current HIV Research, 9, 367-382. http://dx.doi.org/10.2174/157016211798038533
[2]	Mills, E.J., Nachega, J.B., Bangsberg, D.R., Singh, S., Rachlis, B., Wu, P., Wilson, K., Buchan, I., Gill, C.J. and Cooper, C. (2006) Adherence to HAART: A Systematic Review of Developed and Developing Nation Patient-Reported Barriers and Facilitators. PLoS Medicine/Public Library of Science, 3, e438.
[3]	Gupta, A., Nadkarni, G., Yang, W.T., Chandrasekhar, A., Gupte, N., Bisson, G.P., Hosseinipour, M. and Gummadi, N. (2011) Early Mortality in Adults Initiating Antiretroviral Therapy (ART) in Lowand Middle-Income Countries (LMIC): A Systematic Review and Meta-Analysis. PLoS ONE, 6, e28691. http://dx.doi.org/10.1371/journal.pone.0028691
[4]	Abdool Karim, S.S., Churchyard, G.J., Karim, Q.A. and Lawn, S.D. (2009) HIV Infection and Tuberculosis in South Africa: An Urgent Need to Escalate the Public Health Response. Lancet, 374, 921033.
[5]	Munderi, P., Grosskurth, H., Droti, B. and Ross, D.A. (2012) What Are the Essential Components of HIV Treatment and Care Services in Low and Middle-Income Countries: An Overview by Settings and Levels of the Health System? AIDS, 26, S97-S103. http://dx.doi.org/10.1097/QAD.0b013e32835bdde6
[6]	Sanne, I.M., Westreich, D., Macphail, A.P., Rubel, D., Majuba, P. and Van Rie, A. (2009) Long Term Outcomes of Antiretroviral Therapy in a Large HIV/AIDS Care Clinic In Urban South Africa: A Prospective Cohort Study. Journal of the International AIDS Society, 12, 1-11.
[7]	Emamzadeh-Fard, S., Fard, S.E., Seyed Alinaghi, S. and Paydary, K. (2012) Adherence to Anti-Retroviral Therapy and Its Determinants in HIV/AIDS Patients: A Review. Infectious Disorders—Drug Targets, 12, 346-356. http://dx.doi.org/10.2174/187152612804142251
[8]	http://www.health-e.org.za/uploaded/c0b24898135d6363351d590125ba7a6b.pdf
[9]	Lane, T., Raymond, H.F., Dladla, S., Rasethe, J., Struthers, H., McFarland, W. and McIntyre, J. (2011) High Prevalence among Men Who Have Sex with Men in Soweto, South Africa: Results from the Soweto Men’s Study. AIDS & Behavior, 15, 626-634. http://dx.doi.org/10.1007/s10461-009-9598-y
[10]	Senn, T.E. and Carey, M.P. (2009) HIV Testing among Individuals with a Severe Mental Illness: Review, Suggestions for Research, and Clinical Implications. Psychological Medicine, 39, 355-363. http://dx.doi.org/10.1017/S0033291708003930
[11]	Bravo, P., Edwards, A., Rollnick, S. and Elwyn, G. (2010) Tough Decisions Faced by People Living with HIV: A Literature Review of Psychosocial Problems. AIDS Reviews, 12, 76-88.
[12]	Whetten, K., Reif, S., Ostermann, J., Pence, B.W., Swartz, M., Whetten, R., Conover, C., Bouis, S., Thielman, N. and Eron, J. (2006) Improving Health Outcomes among Individuals with HIV, Mental Illness, and Substance Use Disorders in the Southeast. AIDS Care, 18, S18-26. http://dx.doi.org/10.1080/09540120600839330
[13]	Collins, P.Y., Berkman, A., Mestry, K. and Pillai, A. (2009) HIV Prevalence among Men and Women Admitted to a South African Public Psychiatric Hospital. AIDS Care, 21, 863-867. http://dx.doi.org/10.1080/09540120802626188
[14]	Weiser, S.D., Wolfe, W.R. and Bangsberg, D.R. (2004) The HIV Epidemic among Individuals with Mental Illness in the United States. Current HIV/AIDS Reports, 1, 186-192. http://dx.doi.org/10.1007/s11904-004-0029-4
[15]	Sorsdahl, K.R., Mall, S., Stein, D.J. and Joska, J.A. (2011) The Prevalence and Predictors of Stigma amongst People Living with HIV/AIDS in the Western Province. AIDS Care, 23, 680-685. http://dx.doi.org/10.1080/09540121.2010.525621
[16]	Walkup, J.T., Sambamoorthi, U. and Crystal, S. (2004) Use of Newer Antiretroviral Treatments among HIV-Infected Medicaid Beneficiaries with Serious Mental Illness. Journal of Clinical Psychiatry, 65, 1180-1189. http://dx.doi.org/10.4088/JCP.v65n0905
[17]	Conover, C.J., Weaver, M., Ang, A., Arno, P., Flynn, P.M. and Ettner, S.L. (2009) HIV/AIDS Treatment Adherence, Health Outcomes and Cost Study. Costs of Care for People Living with Combined HIV/AIDS, Chronic Mental Illness, and Substance Abuse Disorders. AIDS Care, 21, 1547-1559. http://dx.doi.org/10.1080/09540120902923006
[18]	Joska, J.A. and Sorsdahl, K.R. (2012) Integrating Mental Health into General Health Care: Lessons from HIV. African Journal of Psychiatry, 15, 420-423. http://dx.doi.org/10.4314/ajpsy.v15i6.52
[19]	Moosa, M.Y.H., Jeenah, F.Y. and Kazadi, N. (2007) Treatment Adherence. South African Journal of Psychiatry, 13, 40-45.
[20]	Himeloch, S., Brown, C.H. and Walkup, J. (2009) HIV Patients with Psychiatric Disorders Are Less Likely to Discontinue HAART. AIDS, 23, 1735-1742. http://dx.doi.org/10.1097/QAD.0b013e32832b428f
[21]	Sorsdahl, K.R., Mall, S., Stein, D.J. and Joska, J.A. (2010) Perspectives towards Mental Illness in People Living with HIV/AIDS in South Africa. AIDS Care, 22, 1418-1427. http://dx.doi.org/10.1080/09540121003758655
[22]	Fox, M.P. and Rosen, S. (2010) Patient Retention in Antiretroviral Therapy Programs up to Three Years on Treatment in Sub-Saharan Africa, 2007-2009: Systematic Review. Tropical Medicine & International Health, 15, 1-15. http://dx.doi.org/10.1111/j.1365-3156.2010.02508.x
[23]	Mugavero, M.J., Davila, J.A., Nevin, C.R. and Giordano, T.P. (2010) From Access to Engagement: Measuring Retention in Outpatient HIV Clinical Care. AIDS Patient Care & Stds, 24, 607-613. http://dx.doi.org/10.1089/apc.2010.0086
[24]	Delva, W., Eaton, J.W., Meng, F., Fraser, C., White, R.G., Vickerman, P., Boily, M.C. and Hallett, T.B. (2012) HIV Treatment as Prevention: Optimising the Impact of Expanded HIV Treatment Programmes. PLoS Medicine/Public Library of Science, 9, e1001258.
[25]	Sahay, S., Reddy, K.S. and Dhayarkar, S. (2011) Optimizing Adherence to Antiretroviral Therapy. Indian Journal of Medical Research, 134, 835-849. http://dx.doi.org/10.4103/0971-5916.92629
[26]	Jonsson, G., Furin, J., Jeenah, F., Moosa, M.Y., Sivepersad, R., Kalafatis, F. and Schoeman, J. (2011) Human Rights, Mental Illness, and HIV: The Luthando Neropsychiatric HIV Clinic in Soweto, South Africa. Health & Human Rights, 13, E64-72.
[27]	Rosen, S., Fox, M.P. and Gill, C.J. (2007) Patient Retention in Antiretroviral Therapy Programs in Sub-Saharan Africa: A Systematic Review. PLoS Medicine/Public Library of Science, 4, 1691-1701.
[28]	Rosen, S. and Fox, M.P. (2011) Retention in HIV Care between Testing and Treatment in Sub-Saharan Africa: A Systematic Review. PLoS Medicine/Public Library of Science, 8, 1-16.
[29]	Kazadi, N.J.B., Moosa, M.Y.H. and Jeenah, F.Y. (2008) Factors Associated with Relapse in Schizophrenia. South African Journal of Psychiatry, 14, 52-62.
[30]	Awad, G.A. (2004) Antipsychotic Medications: Compliance and Attitude towards Treatment. Current Opinion in Psychiatry, 17, 75-80. http://dx.doi.org/10.1097/00001504-200403000-00002
[31]	Ammassari, A., Trotta, M.P., Shalev, N., Marconi, P. and Antinori, A. (2012) Beyond Virological Suppression: The Role of Adherence in the Late HAART Era. Antiviral Therapy, 17, 785-792. http://dx.doi.org/10.3851/IMP2084
[32]	Scanlon, M. and Vreeman, C. (2013) Current Strategies for Improving Access and Adherence to Antiretroviral Therapy in Resource-Limited Settings. HIV AIDS (Auckl), 5, 1-17.