Factors associated with attendance at first clinic appointment in HIV positive psychiatric patients initiated on antiretroviral therapy (ART) as in-patients

Thesis (M.Med.(Psychiatry))--University of the Witwatersrand, Faculty of Health Sciences, 2014.The Luthando Neuropsychiatric HIV clinic was set up at Chris Hani Baragwanath Academic Hospital as an anti-retroviral roll out centre, specifically designed to provide anti-retroviral therapy to HIV positive patients with a psychiatric illness. Adherence to HIV treatment is essential for virological suppression, and non-adherence is a key factor in treatment failure. Research has suggested that psychiatric illness may negatively influence adherence to ART. Importantly, negative perceptions with regards to adherence may affect the decision to initiate ART in psychiatric patients. Attendance at clinic appointments is the first step in adherence, and has been found to be one of the most important predictors of medication adherence. Attendance at first clinic appointment is easily measurable in a limited resource setting, such as South Africa. The aim of this study was to examine the rate of attendance at the first clinic appointment post discharge from psychiatric hospitalization in HIV positive psychiatric patients initiated on ART as in-patients, and to determine which factors, if any may be related to clinic attendance. This study was a retrospective record review, conducted at Chris Hani Baragwanath Academic Hospital, at the Luthando clinic. Patients that were initiated on ART as psychiatric in-patients, 18 years to 65 years of age from 1st July 2009 to 31st December 2010 and then discharged for follow up as out-patients at Luthando clinic were included in the sample. The primary outcome was attendance at the clinic post discharge from hospital. Socioeconomic and clinical data were also recorded and analysed, comparing attendant and non-attendant P a g e | vi groups. The rate of attendance was 79.59%. There were a number of similarities between the attendant and non-attendant patients in terms of demographic and clinical data. The only significant difference between the attendant and non-attendant groups was disclosure of HIV status, and significantly fewer non-attendant patients had disclosed their HIV status to their treatment supporter (p = .01). Further research needs to quantify the significance of in-patient vs. out-patient initiation of ART, as well as to investigate the impact of a psychiatric diagnosis on attendance at ART clinics. Non-disclosure of HIV status needs to be further investigated and addressed in HIV treatment facilities in order to improve attendance