FACTORS CONTRIBUTING TO LOST TO FOLLOW UP AMONG

HIVPOSITIVE CLIENTS AT KAKANJU HEALTH CENTER III BUSHENYI

DISTRICT

A RESEARCH REPORT SUBMITTED TO THE UGANDA NURSES AND

MIDWIVES EXAMINATIONS BOARD

IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE AWARD

OF A DIPLOMA IN NURSING

BY

ATUKWATSE MACKLINE

NSIN: M17/U011/DNE/009

NOVEMBER, 2018

i
i
 ABSTRACT

A study from 23 countries indicate that average retention for people on ART

decreases over time, from about 86% at 12months to 72% at 60months.

The aim of this study was to establish factors contributing to lost to follow up among

HIV positive clients at Kakanju Health Centre iii Bushenyi District.

The study was a descriptive case study that used simple random method among 71

respondents who included HIV positive clients and both medical and nursing staff

working on ART clinic.

The study established that both clients and health workers were responsible for the

factors contributing to lost to follow up. Client factors included: 49 (69%) were

feeling stigmatized when seen by others at the clinic, 45 (63.4%) lacked family

support, and 61 (85.9%) lacked nutritional support while on treatment. The Health

facility related factors included; 40 (56.3%)of the respondents reported that they

could find 2-3staffs on duty,and 36 (50.7%) reported the distance to the health facility

from home to be more than 3kilometres.

The study concluded that with the identified factors, lost to follow up has been a

struggle sometimes leading to death of HIV positive clients. Hence, the health

facility management should employ more staff, arrange for education sessions within

the health facility and provide laboratory services even on weekends and at night.

i
 COPYRIGHT

Copyright©(2018) by (Atukwatse Mackline)

ii
 AUTHORIZATION.

This unpublished research report submitted to Kampala International University

School of Nursing and Midwifery and deposited in the library is open for inspection

but is to be used with the regards to the right of the author. The author and the school

of nursing grant privilege of loan or purchase of Microfilm or photocopy to

accredited borrowers provided is given in subsequent written or published work.

Author:

ATUKWATSE MACKLINE…………………………..Date………………….

Tel. 0779934210/0703611400

Supervisor.

Ms TURINAWE SYLVIA……………….…………Date…………...………

Address:0702366326

PRINCIPAL:

KABANYORO ANNET………………………………..Date…….……………

iii
 DEDICATION

This report is dedicated to my dear husband, Mr. Tindyebwa Januario and my lovely

sons Abaine Francis and Abigaba Joshua for their encouragement and support that

enable me to reach up to this stage of study.

I also dedicate it to my dear parents, brothers, sisters and my sister in-law

Tumuramye Javiila with her husband Mr. Kiiza K Adrian for their sacrifice, support

and tender loving care.

Thanks to the Almighty father for his amazing Grace that has enabled me to reach up

to this level of study.

iv
ACKNOWLEDGEMENT

I would like to give my special thanks to my supervisor, Madam Tulinawe Sylvia for

her tireless support and guidance during development of my report.

I also acknowledge the ethics and research committee of Kampala International

University School of Nursing science for their review and approval of my report.

I acknowledge the management of Bushenyi district local government, the district

health officer who allowed me to carry out the study in their institution. I also thank

the health workers at kakanju health Centre iii for their heartily support to enable the

collection of the data.

I will not forget to acknowledge the in-charge at kakanju health Centre iii who

willingly accepted me at his or her facility.

Finally, my sincere appreciation goes to my husband, Mr.Tindyebwa Januario and my

lovely sons Abaine Francis and Abigaba Joshua for their everlasting support.

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 TABLE OF CONTENTS

ABSTRACT .............................................................................................................. I

COPYRIGHT ........................................................................................................... II

AUTHORIZATION . ....................................... ERROR! BOOKMARK NOT DEFINED.

DEDICATION ....................................................................................................... IV

ACKNOWLEDGEMENT .......................................................................................V

LIST OF FIGURES. .................................................................................................X

LIST OF TABLES ................................................................................................. XI

LIST OF ABBREVEATIONS .............................................................................. XII

DEFINITION OF TERMS ................................................................................... XIII

CHAPTER ONE ...................................................................................................... 1

1.1 BACKGROUND AND INTRODUCTION ....................................................... 1

1.2 PROBLEM STATEMENT ................................................................................ 4

1.3 BROAD OBJECTIVE........................................................................................ 5

1.4 SPECIFIC OBJECTIVES .................................................................................. 5

1.5 RESEARCH QUESTIONS ................................................................................ 5

1.6 JUSTIFICATION ............................................................................................... 5

1.6.1. TO THE NURSING MANAGEMENT ..................................................................... 5

1.6.2. TO THE NURSING PRACTICE ............................................................................ 6

1.6.3. TO THE NURSING RESEARCH AND EDUCATION ................................................ 6

CHAPTER TWO: LITERATURE REVIEW .......................................................... 7

2.1. INTRODUCTION............................................................................................. 7

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2.2. CLIENT FACTORS ATTRIBUTED TO THE LTFU OF HIV CLIENTS ....... 7

2.2.1. STIGMA ........................................................................................................... 7

2.2.2. FEAR OF DRUG SIDE EFFECTS ........................................................................... 8

2.2.3 LACK OF FAMILY SUPPORT ............................................................................... 8

2.2.4 NUTRITIONAL SUPPORT/LACK OF ENOUGH FOOD WHILE ON TREATMENT.......... 9

2.2.5 SEX .................................................................................................................. 9

2.2.6. STAGE OF THE DISEASE ................................................................................. 10

2.3. HEALTH FACILITY FACTORS ................................................................... 11

2.3.1 SHORTAGE OF STAFF ...................................................................................... 11

2.3.2 POOR ATTITUDE TOWARDS HIV PATIENTS ..................................................... 11

CHAPTER THREE: METHODOLOGY............................................................... 13

3.1 INTRODUCTION.................................................................................................. 13

3.2 STUDY DESIGN ............................................................................................. 13

3.3 STUDY SETTING ........................................................................................... 13

3.4 STUDY POPULATION................................................................................... 14

3.4.1 SAMPLE SIZE DETERMINATION ............................................................ 14

3.4.2. SAMPLING PROCEDURE ......................................................................... 15

3.4.3. INCLUSION CRITERIA ............................................................................. 16

3.4.4 EXCLUSION CRITERIA ............................................................................. 16

3.5 DEFINITION OF VARIABLES ...................................................................... 16

3.6 RESEACH INSTRUMENTS ........................................................................... 16

3.7 DATA COLLECTION PROCEDURES .......................................................... 17

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3.7.1 DATA MANAGEMENT .............................................................................. 18

3.7.2 DATA ANALYSIS ....................................................................................... 19

3.8 ETHICAL CONSIDERATIONS ..................................................................... 19

3.9 LIMITATION OF THE STUDY...................................................................... 20

3.10 DISSEMINATION OF RESEARCH FINDINGS ......................................... 21

CHAPTER FOUR. ................................................................................................. 22

4.0 DATA ANALYSIS, PRESENTATION AND INTERPRETATION. ............. 22

4.1 DEMOGRAPHIC CHARACTERISTICS OF RESPONDENTS .................... 22

CHAPTER FIVE.................................................................................................... 32

DISCUSSION, CONCLUSION, NURSING IMPLICATION AND

RECOMMENDATION. ........................................................................................ 32

5.1. DISCUSSION. ................................................................................................ 32

5.1.1. CLIENT FACTORS. .................................................................................... 32

5.1.2. HEALTH FACILITY FACTORS. ............................................................... 34

5.2. CONCLUSION. .............................................................................................. 35

5.3. RECOMMENDATIONS ................................................................................ 36

5.4. NURSING IMPLICATION. ........................................................................... 36

REFERENCES ...................................................................................................... 38

APPENDICES ....................................................................................................... 43

(I): CONSENT FORM ........................................................................................... 43

viii
APPENDIX II:A QUESTIONNAIRE FOR HIV/AIDS CLIENTS ABOUT FACTORS

THAT CONTRIBUTE TO LOST TO FOLLOW-UP AMONG HIV CLIENTS AT

KAKANJU H/CIII ................................................................................................. 44

APPENDIIX; III A QUESTIONNAIRE FOR HEALTH WORKERS ABOUT

FACTORS THAT CONTRIBUTE TO LOST TO FOLLOW-UP AMONG HIV

CLIENTS. .............................................................................................................. 48

APPENDIIX; IV INTRODUCTORY LETER ....................................................... 51

APPENDIX V: A MAP OF UGANDA SHOWING BUSHENYI DISTRICT ...... 52

APPENDIX VI: AMAP OF BUSHENYI DISTRICT SHOWING KAKANJU H/CIII

................................................................................................................................ 53

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 LIST OF FIGURES.

Figure 1 Showing responses for clients who had ever reacted on drugs……….25

Figure 2 Showing reasons for clients whose return was affected by sex their….27

Figure 3 Showingthe stage at which the clients started treatment………..……28

Figure 4 Showing the number of staff met on duty during the clinic……………29

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 LIST OF TABLES

Table 1: Demographic Characteristics of respondents…………………………..…22

Table 2:Whether client had ever missed an appointment return date to the clinic....23

Table 3: Showing client related factors contributing to lost to follow up…………..24

Table 4: Showing client related factors contributing to lost to follow up…….…….26

Table 5:Showing respondents responses on health facility factors………….…..…30

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 LIST OF ABBREVEATIONS

AIDS: Acquired Immunodeficiency Syndrome

ART: Antiretroviral Therapy

H/C III: Health Center three

HIV: Human Immunodeficiency Virus

KHIMS: Kakanju Health Information Management System

KI: Key Information’s

KIIG: Key information Interview Guide

KM: Kilometer

LMICs: Low and Middle-Income Countries

LTFU: Last To Follow Up

MOH: Ministry of Health

PLWHIV: People living with HIV/AIDS

UNAIDS: The Joint United Nations programme on HIV/AIDS

WHO: World Health Organization

KIU: Kampala International University

UNMEB: Uganda Nurses and Midwives Examination Board

xii
 DEFINITION OF TERMS

Pre-testing: Determining the effectiveness of the survey questionnaire

Pre-visiting: To create efficient patient work flow

Immune: Resistance possessed by the body to infectious disease, foreign

tissues, foreign nontoxic substances and other antigens.

Mortality: The state of being liable to die.

Mortality rate: Number of deaths per 1000 occurring annually from a certain

or condition.

Paroxysm: A sudden recurrent attack of a symptom of disease.

Population: A people living in the area under study

Resistance: The abilityto withstand or oppose the effect of something.

Symptom: Change in the body’s condition that indicates illness.

xiii
 CHAPTER ONE

1.1 BACKGROUND AND INTRODUCTION

Lost to follow-up [LTFU] is defined as an incomplete ascertainment of the primary

outcome for participants, when 180 days or more have lapsed since the patients last

clinic visit (Chi BH, et al, 2011).

In most settings, regular attendance at the health facility is critical to the

comprehensive medical care of HIV infected patients, during these visits health

workers examine patients for clinical progression, provide and monitor combination

antiretroviral therapy and counsel them on minimizing risk of HIV transmission (Fox

MP, et al, 2010).

Despite this need for regular monitoring, significant loss of follow-up has been

demonstrated in antiretroviral therapy programs; and cohort studies- both in

Industrialized and resource –limited settings at rates often exceeding reported

mortality (Fox MP, et al, 2010).

Globally approximately 33million people are living with HIV infection or AIDS; and

majority being women and children compared to men (UNAIDS 2009).

Unfortunately potential in HIV program is a huge problem; a large proportion 30-

60% in some settings in sub Saharan Africa are lost to follow-up and stop taking

treatment (Norma C, et al, 2013).

1
A systematic review of sub Saharan Africa cohort reported lost to follow-up rates as

high as 35% in 3years following Antiretroviral therapy initiation Fox MP, et al,

(2010), a finding supported by other regional reports ( Ekovevi, et al, 2010).

According to Ethiopia, HIV related estimates and projection for the year 2012

showed that there are 759260 people living with HIV/AIDS [PLWHIV] which is

1.3% of the national adult HIV prevalence (MOH, 2009). Of the 580909 people living

with HIV/AIDS who had been enrolled in chronic care, 333434 had started

antiretroviral therapy [ART] but only 247805 were currently on treatment (MOH,

2009).

Research in Malawi and Kenya on people in urgent need of Antiretroviral

therapy[(ART] has shown large number of patients lost to follow-up before they are

able to initiate treatment, with the highest rates of lost to follow-up during the first

two months after enrolment in the care, prior to commencing Antiretroviral therapy,

Baseline attrition rates in Kenya and Malawi is between 20-50% (Zachariah R, et al,

2010).

A research carried out in the Ugandan western district of Mbarara showed that 3628

HIV infected adults newly initiating ART, 827 were lost to follow-up. The median

time from lost clinic visit to tracking was 11.6 months and the median distance from

residence to clinic was 33km. The cumulative incidence to lost to follow-up was

16% during year one, 30% during year two and 39% during year three. Of the 829

people lost to follow-up, a sample of 125(15%0 was sought of these clients, 17 (13%)

were not found 32 (25%) had died and 78 (62%) were alive (Geng EH, et al,2010). In

2
kakanju Health Centre iii, 12(8.45%) clients on average are lost to follow up

annually(HMIS, 2017). It is therefore against the above background the researcher is

interested to investigate on the factors contributing to lost to follow up among HIV

positive clients.

3
1.2 PROBLEM STATEMENT

Studies in sub-Saharan Africa have shown that about half of people who test HIV-

positive are lost between testing and being assessed for eligibility for therapy, and

32% of people considered eligible for ART are then lost between eligibility

assessment and initiation of ART( Wools-Kaloustian K, et al.2009). LTFU negatively

impacts on the immunological benefit of ART and increases AIDS-related morbidity,

mortality, and hospitalizations (Tezera M.B, 2014). Despite government interventions

which include set up and maitain simple standardized monitoring systems , reliably

ascertain true treatment outcomes , ensure uninterrupted ART drug supplies, and

strengthen free ART regimens, decentralize ART links within and between the health

service and community ( AD Harries, 2010), studies in Uganda show that up to 50%

of HIV clients are LTFU during either antenatal,postnatal period or after 1-2years of

ART initiation (Bassani, et al, 2012). In Kakanju health Centre III, there were 28%

lost to follow-up HIV positive clients within a period of three years out of a total of

142 HIV (KHIMS, 2018) .Therefore , HIV postive clients will fail to contiue with

their treatment plan, increasing the percentage of lost to follow up hence increasing

AIDS related morbidity, mortality and hospitalisation.

It is therefore essential to understand how and why people drop out of treatment

programs, since retention of people on ART and ensuring adherence to treatment are

critical determinants of successful long-term outcomes It is against this problem that

the researcher intends to establish the factors contributing to lost to follow-up of HIV

positive clients.

4
 1.3 BROAD OBJECTIVE

To establish the factors that contribute to lost- to follow- up among HIV positive

clients at Kakanju health Centre III Bushenyi district

1.4 SPECIFIC OBJECTIVES

1. To assess the client related factors contributing to lost to follow-up among HIV

positive clients at Kakanju health Centre III.

2. To establish health facility factors contributing to lost follow-up (L.T.F.U) among

HIV positive clients at Kakanju health Centre III.

1.5 RESEARCH QUESTIONS

1. What are the clients related factors contributing to lost to follow-up

(L.T.F.U) among HIV positive clients at kakanju health Centre III?

2. What are the health facilities factors contributing to lost to follow-up among

HIV positive clients at kakanju health Centre III?

1.6 JUSTIFICATION

Despite the efforts by governments and donors to increase awareness and improve

lives of people living with HIV, many have become lost to follow-up. The findings of

the study will therefore be helpful in the following aspects;

1.6.1. To the nursing Management

To generate knowledge to stakeholders, ministry of health Bushenyi district and

facility administration to enforce improved quality of care to HIV positive clients.

5
1.6.2. To the Nursing practice

The study will help to lay strategies to increase outreach services and awareness to

the communities about HIV positive living and compliance to ARVS.

1.6.3. To the Nursing research and education

The study will act as data base for other researchers also help in the fulfillment for

the award of diploma in nursing for the researcher.

6
 CHAPTER TWO: LITERATURE REVIEW
2.1. INTRODUCTION

This chapter reviews what other individuals have discovered in relation to the factors

attributed to lost-to-follow up of HIV clients. This is gotten from books, websites,

journals, reports, to mention. The review of literature shall be guided by the following

sub-headings;

 Client factors attributed to the lost-to-follow up HIV clients.

 Health facility factors contributing to the lost-to-follow up HIV clients.

2.2. CLIENT FACTORS ATTRIBUTED TO THE LTFU OF HIV CLIENTS

2.2.1. Stigma

Stigma is a major barrier in prevention and treatment of HIV, Stigma associated with

HIV and AIDS is a complex concept that has been described as the third epidemic

(Ware, et al, 2009). In a study done in Tanzania in ilala municipal council of fare

72(60%), Stigma, shift from one clinic to another and use of traditional medicine

where found to be the factors contributing to the loss of follow up visits. However,

lack of space (92%), shortage of health providers (94%), stigma and discrimination

(90%), low motivation (94%) and work load (94%) were the challenges facing health

providers during provision of services to HIV patients.(Salema, Judith 2015). Stigma

related to HIV diminishes patient’s access to social capital-norms of trust and

reciprocity an individual can access to solve day to day problem and also impairs

7
retention in care ( Mc Guire, et al, 2010). In India, regular health checkups are not a

routine practice and hence patients avoid going to ART centers on routine basis out of

fear of identification(Joglekar, et al, 2011). In a study from Malawi, stigma led to

non-retention in 45.8% of pre-ART and 25% of on ART patients (Rabkin, et al, 2010)

2.2.2. Fear of drug side effects

According to a study done in South Africa, it showed that there is a lot of fear of drug

side effects among HIV/AIDS clients on ART, especially about tablets and of

subjugating one’s anatomy to the health care system (Hodes R, 2010). similar to an

Indian study that reported that substitution of drugs can be risk factor for ART

default.(Alvarez-Uria G, et al, 2013).The majority of regimen substitution cases in

this study were due to adverse drug reactions, so these patients may have become

concerned about side effects and the effectiveness of new medication, causing them

to seek other treatment options (MOH of Ethiopia, 2010). In the Themba Lethu Clinic

in Johannesburg, among 70 patients who were LTFU,only 4.1% cited side effects as a

reason for failure to return to the clinic (Maskew, et al, 2009).

2.2.3 Lack of family support

A final report in Swaziland by MOH/WHO (2010) about assessment of lost to follow-

up and associated factors among ART clients revealed that lack of family support

contributed to clients withdraw from the ART clinic. This was supported by 30% of

the respondents. In a study from Kenya, a target program providing social support for

8
youth found retention was better at the intervention clinic with 70% remaining in the

active care versus 55% at the general site for the same age group (Otieno, et al, 2011)

2.2.4 Nutritional support/lack of enough food while on treatment

According to a health worker in Zimbabwe where malnutrition is widespread, it was

explained that taking ART on an empty stomach was like digesting razor blades and

the result was that many simply could get lost from the clinic (The Guardian 2009). A

similar study in Zambia showed that death rates in the first three months of starting

ART were highest (95%) among the most malnourished (Koeth J, 2010).

In a Conclusive study done in Ethiopia,Lipid based nutritional supplements improved

gain of weight, lean body mass, and grip strength in patients with HIV starting

ART.Supplements containing whey were associated with improved immune recovery

(Mette F Olsen, 2014).

2.2.5 Sex

A study conducted in Kenya about the influence of gender on lost to follow-up

revealed that men with HIV infection are merely likely to become LTFU, both before

and after starting combination ART. The study further showed that of the 8% of

individuals who never returned after their enrollment,65% were males..(Ochieng-

Ooko V. et al.2009).

In a South African study, even though 30% of the clinics were men, 42% 0f the

missed visits during a 2-month window were by men (Maskew, et al, 2010). In the

West Africa IeDEA consrtium, with 13102 patients from 11cohorts from Benin, the

9
Ivory Coast, Gambia, Mali, and Senegal, men had a 10% higher hazard of failure to

retain (Ekouevi, et al, 2010). Again, given the overall higher likelyhood that men

travel for work-particularly in professions of truck drivers, fishermen and migrant

agricultural workers,the observed association between men and loss to follow –up

may be due at least in part to migratory labor pattern (Largarde etal,2016). Similarly,

another study showed that loss to clinic among women who were pregnant at

enrollment who were in pre-partum period did not return perhaps as a consequences

of increased domestic demands in caring for the newborn (Leisegang R.N.J, 2011).

2.2.6. Stage of the disease

A study by (Tezera Moshago B, et al, 2014),showed that Patients with advanced

clinical stage (III and IV) at entry were less likely to be lost to follow-up, it suggested

that clinical stage III and IV patients have increased health-seeking behavior.Outside

Africa, a Swiss study showed a statistically non-significant trend,( Schoni-Affolter F,

et al, 2011) but a French study, similar to ours showed that a history of an AIDS-

defining illness was associated with reduced LTFU.(Tezera Moshago B, et al,

2014).A related study in Kwazillu Nated in South Africa revealed that only 49.4% of

individual with an initial CD4+ calcocent >2001cc returned for a subsequent CD4

measurement within the next 13 months (Lessells R, et al, 2009).

10
2.3. HEALTH FACILITY FACTORS

2.3.1 Shortage of staff

On average, there are 15 times the number of doctors and 8 times the number of

nurses in Europe compared to Africa (WHO, 2008). The WHO estimates that the

global shortage of trained health care staff exceeds 4 million (WHO, 2010). As a

result of increased work load due to low staff-client ratio, long waiting times has

resulted which has prompted several subjects to abandon treatment. As if that is not

enough, patients also reported long queues, difficulty in booking appointments to the

clinics with no enough time spent with the provider (Jogleckar N, etal, 2011). In a

study done in Tanzania in ilala municipal council lack of space (92%),shortage of

health providers (94%), stigma and discrimination (90%), low motivation (94%) and

work load (94%) were the challenges facing health providers during provision of

services to HIV patients (Salema, Judith 2015).

2.3.2 Poor attitude towards HIV patients

A study in Lagos state in Nigeria showed that attitude towards people living with

AIDS (PLWAs) was poor, Some 55.9% of the health workers felt that people living

with AIDS are responsible for their illness, while some 35.4% felt that they deserved

the punishment for their sexual misbehaviors (Adebajo, et al, 2010). According to Lui

S, et al, (2011), it was further found out that health workers portrayed high level of

negative attitude towards clients from vulnerable groups with regards to the

transmission and spread of HIV.

11
Distance to the health facility.

According to a study conducted in Malawi ,it was found out that the most common

reason cited by patients for defaulting was travelling long distance (Luebbert J, et al,

2010 ).

A similar study by Geng EH, (2009) show that transportation has remained a

hindering factor to HIV clients from returning to clinics ;as evidenced by 50% of the

participants who reported lack of transport as one of the primary reasons for not

returning to the HIV clinic.

In uganda, a study conducted about mortality and loss to follow-up during pre-

treatment period in an ART programme showed that almost half of the clients who

were still alive at the follow-up visit said they did not complete screening because

they could not afford costs to come to clinics. This showed that for many families the

high cost of transport was a major barrier preventing them to access ART; Therefore

leading to loss of follow-up.(Amuron B, et al, 2010). Furthermore, the study found

out that if travel time to clinic exceeded 2 hours, the risk of non-retention was

doubled (Rabkin, et al, 2010). More so, a study conducted in Mbarara, individuals

were randomised to receive a cash transfer of 10000 to 15000 Uganda Shillings ($5-

$8) to be used for transportation. Only 14 (18%) patients were lost to follow up from

the intervention group, versus 23 (34%) Emenyonu, et al, (2010). Another study in

South Africa showed that of the 20 clients who were transfered to new treatment

sites, 16 had lower transport costs to get to the new clinic (Miller M, 2010).

12
 CHAPTER THREE: METHODOLOGY

3.1 Introduction

This chapter describes the method that was used in the study. It includes the

description of the study area, study population and the sampling techniques. It gives

an explanation of how data collection, quality analysis and presentation shall be

carried out. It also addresses the issues of limitation and ethical consideration related

to the study. It ends with a plan on how results of the study shall be disseminated.

3.2 STUDY DESIGN

The study was a descriptive case study. It helped the researcher to assess client and

establish health facility related factors contributing to lost to follow-up among HIV

positive clients at Kakanju H/Ciii

The study design was convenient for the small scale (case) study, was time saving

and less costly.

3.3 STUDY SETTING

The study was conducted in Kakanju H/CIII. The area was selected due to the fact

that it was easily accessible by the researcher and had the appropriate respondents

who could answer the research questions to meet the objective of this study. Kakanju

H/CIII is located about 370 km from Kampala the capital city of Uganda and found in

Bushenyi district about 10 km from Ishaka Bushenyi municipality (the district main

town), Igara West Constituency, Kakanju Sub-county, Kakanju parish..

13
The Facility offers preventive, curative, and promotive service. The main tribe is the

Banyankole and the main language spoken in this area is Runyankole. The main

activity carried out in this area is subsistence farming; mainly they grow beans,

cassava, maize and bananas. There is also some trading and rearing of animals in the

area. Geographically, the area has hilly and flat areas and the climate is relatively hot

in certain seasons because of being near the equator line..

3.4 STUDY POPULATION

The study was conducted among HIV/AIDs clients enrolled on treatment and do

come for HIV/AIDs related services in the HIV/AIDs clinic at Kakanju H/CIII.

3.4.1 SAMPLE SIZE DETERMINATION

The sample size was determined by using the fisher’s formula (1990) formula as

below:

N=

Where N is the sample size,

Z2 is the abscissa of the normal curve that cuts off an area α at the tails;

(1 – α) equals the desired confidence level, e.g., 95%);

e is the desired level of precision(0.05),

p is the estimated proportion of an attribute that is present in the population(27%),and

q is 1-p.

N = 0.952 x 0.27 (1- 0.27)

0.052

14
N = 0.17788275

0.0025

N= 71

The total sample size of clients that was included in the study was 71 clients.

The study comprised of 71 clients as respondents who were present on the HIV/AIDS

Kakanju H/CIII and this number of respondents was selected to be a fair

representation of the whole population to provide reliable data and was a convenient

number for the researcher in terms of cost.

3.4.2. SAMPLING PROCEDURE

Selection of clients

A simple random sampling was used to get the 71 clients for the study and the

researcher collected data for five days. A random sample of 71 clients were selected

from 14 clients received each day.

Selection of Health care workers

Simple random sampling was used to select the five (5) respondents, from 10 staffs

working on the department. Five (5) pieces of paper labeled “A” and other 5pieces of

paper labeled “Z”, were folded and put in a small box, and staff were requested to

pick randomly. Those who picked papers labeled “Z”, shall be selected for the study.

And the study also involved the in-charge HIV/AIDs clinic who was the key

informant, to provide more variable information during the study.

15
3.4.3. INCLUSION CRITERIA

The study included only HIV/AIDs clients enrolled on life supportive treatment, who

were present during the time of data collection and only those who accepted to

participate in the study.

3.4.4 EXCLUSION CRITERIA

Those who are HIV/AIDS clients enrolled on ART who were not available at time of

data collection and those who did not consent to participate during sampling were

excluded in the study.

3.5 DEFINITION OF VARIABLES

 Dependent variables.

Lost-to-follow up

 Independent variables.

Client factors

These are defined as factors attributed to lost-to-follow up associated to the client.

Health facility factors

These are factors contributing to lost-to-follow up of HIV clients.

3.6 RESEACH INSTRUMENTS

Questionnaires involving both open-ended and closed-ended questions were used to

collect data from the principal respondents and a key Informant Interview Guide

(KIIG), for secondary respondents who were the Key Informants (KI).

16
3.7 DATA COLLECTION PROCEDURES

It was done under the following headings.

 Training of research assistants.

Two research assistants who were the health workers were trained and introduced to

the study objectives, and it reduced on the work load and time spent during data

collection.

Pre-testing

All questionnaires were pre-tested from ART clinic using clients who were not be

primary respondents in the study. This helped the researcher to determine the content,

validity, relevancy, accuracy and reliability of the research tools and identified the

changes to be made before data collection.

 Pre visiting

The researcher pre-visited HIV department on which the study was to be carried out.

This was necessary for the researcher to get familiar to the arrangements on the

department. It involved mobilizing the department in-charge for the relevancy of the

study objectives.

 Quantitative data

Data was collected using a questionnaire. This interview questionnaire had both

structured and non-structured questions. Open and closed –ended questions were used

to enable respondents to answer each question paused. The questionnaire was self-

administered, to allow accurate recording of respondents’ responses.

17
 Qualitative data

This data was collected using the KIIG to influential people who were health workers.

The guide included issues that needed more information in depth to supplement on

the information obtained from respondents.

3.7.1 DATA MANAGEMENT

 Editing

Research instruments were checked for errors and omission so as to ensure

consistency, completeness and accuracy in filling them. This was done in the field

after the questionnaire was filled. Elaborating answers were written in a note book.

 Data storage

Data was stored in safe custody by not allowing other people to look in the already

filled questionnaire. While in the field, recorded or filled questionnaires were stored

in water proof and sealed box before analysis of data was done.

 Coding

This was done in the hostel daily after the field. It involved grouping resource into

categories. This was facilitated by constructing coding frames. Each response was

entered by use of double entry, meaning that data of each respondent was entered

twice on separate sheet of paper.

By comparing spread sheet of entered data and corrections were made on detection

of any error. The code was designed and was made exhaustive and representative.

18
3.7.2 DATA ANALYSIS

All notes of interview including KIIGs were transcribed precisely word by word.

After reading the transcription of all interviews, a content analysis was identified.

Thereafter, themes (factors contributing) were developed into categories according to

the research variables. After categorizing data in line with the study variables, the

results of qualitative data were compared with those of quantitative data, findings of

the study were presented as follows;

 Data presentation

The collected data was first processed, analyzed using Microsoft Excel and the results

were presented in descriptive forms of tables, bar graphs, pie charts and texts.

3.8 ETHICAL CONSIDERATIONS

The free and informed consent of each individual participant was obtained at the start

of the study. Respondents were read an informed consent form that would explain the

purpose of the study, what participation in the study was involved, how

confidentiality and anonymity would be maintained, the right to refuse to participate

in the study or to withdraw from the study without any penalty, the benefits and risks

of participating in the study. Study participants were not required to undergo any

invasive procedures. Personal / sensitive issues were explored when a good

relationship was established with the informant. The research team was urged and

required to respect the culture of the respondents during the data collection process.

Confidentiality and anonymity were maintained by the use of code numbers on the

questionnaire other than names. Information that was obtained would only be used for

19
the purposes of this study. The data collected will be accessible only to the people

involved in the study and the principal investigator will store the questionnaires and

other study tools in a lockable filing cabinet.

3.9 LIMITATION OF THE STUDY

The researcher faced some obstacles like, limited time to carry out the study but

however this was overcame by giving research fast priority and using research

assistant to carry out the study, so that more time would be saved for other study

stages.

Stigmatization from respondents to reveal the true information because the study

looked like a performance assessment yet not. This was solved by explaining to

respondent the objectives of the study as well as ensuring confidentiality during and

after data collection.

Inadequate funds to facilitate the research project, this was addressed by soliciting

funds from relatives and friends to carry out the study.

20
3.10 DISSEMINATION OF RESEARCH FINDINGS

The findings of the study were compiled into a dissertation and submitted to the

Uganda Nurses’ and Midwives’ Examination Board (UNMEB), Ministry of

Education and Sports in partial fulfillment for the award of a diploma in nursing.

Other copies of the research report were printed and distributed as follows;

i) Kampala International University (KIU)

ii) Kakanju H/CIII Library

iii) The researcher supervisor.

iv) The researcher

21
 CHAPTER FOUR
4.0 DATA ANALYSIS, PRESENTATION AND INTERPRETATION.

INTRODUCTION.

This chapter analyses, presents and interprets data collected from 71 respondents

about the factors contributing to lost to follow up among HIV/AIDS clients.

The results are presented using tables and figures as follows;

4.1 DEMOGRAPHIC CHARACTERISTICS OF RESPONDENTS

Table 1 Demographic Characteristics of respondents

n=71
Variables Frequency (n) Percentage (%)
Age (years) <19 3 4.2
20-29 37 52.1
30-39 23 32.4
40 and above 8 11.3
Sex Male 22 31
Female 49 69
Married 45 63.38
Marital Single 7 9.86
status Widow/widower 11 15.49
Separated/divorced 8 11.27
Occupation Peasants 57 80.28
Civil servants 2 2.82
Businessmen/women 9 12.68
Others 3 4.22
Level of Never attended school 18 25.35
education Primary( P1-P7) 24 33.8
Secondary (S1-S6) 20 28
Tertiary 9 12.68
Source: Primary data 2018.

22
Slightly more than half 37(52.1%) of the respondents were in the age group of 20-29

years compared to 3(4.2%) who were less than 19 years. Majority 49(69%) of the

respondents were females compared to 22 (31%) who were males. More than a half

45(63.38%) of the respondents were married compared to 7(9.86%) who were single.

Majority 57(80.28%) of the respondents were peasants compared to 2(2.82%) who

were civil servants and slightly more than three quarters 24(33.8%) of the

respondents attended primary (P1-P7) compared to 9(12.68%) who attended tertially.

PATIENT RELATED FACTORS

SECTION B; CLIENT FACTORS ATTRIBUTING TO LOST TO FOLLOW-

UP

Table 2 Showing if client had ever missed an appointment to the clinic.

Variables Frequency (n) Percentage (%)

Whether had ever missed an
appointment return date to the clinic
(n=71)

Yes 62 87.3
No 9 12.7
Reason for missing (n=62)
Lack of money for transport 28 45.2
Long distance 20 32.3
It rained heavily 8 12.9
Was very sick 3 4.8
Stigma 3 4.8
Source: primary data 2018.

23
More than three quarters 62(87.3%) of the respondents had ever missed their

appointment dates to the clinic compared to 9 (12.7%) who had never missed

appointment and majority 28(45.2%) of those who missed reported lacking money for

transport and only 3 (4.8%) reported that they were very sick and stigma.

Table 3 Showing client related factors contributing to lost to follow up.

n=71

Variable Frequency(n) Percentage (%)

How client feels when seen by others at
the clinic
Shy and stigmatized 49 69
Guilty and unhappy 12 16.9
Free 8 11.3
Others 2 2.8
Whether clients feel like disclosing
status
No 57 80.3
Yes 14 19.7
Whether client has ever reacted on
drugs
Yes 54 76.1
No 17 23.9

Source: Primary data 2018.

Majority 49(69%) of the respondents reported that they felt shy and stigmatized when

seen by others as they come to the clinic for treatment compared to 2(2.8%) who

would only mind their own business. More than a half 57(80.3%) of the respondents

24
did not feel like disclosing their status compared to 14(19.7%) who would disclose

their status. More than a half 54(76.1%) of the respondents had ever reacted on HIV

treatment compared to 17(23.9%) who had never reacted on treatment.

n=54

key
Stop visiting the clinic for treatment
stop treatment
consulting their counsellors
6% continue with treatment

24%
44%

26%

Source: Primary data

Figure 1 Showing response of clients after reaction on treatment.

Out of those who had ever reacted on HIV treatment, majority 24(44.4%) of the

respondents reported that would stop visiting the clinic for treatment and only

3(5.6%) would continue with treatment.

25
Table 4 showing client related factors contributing to lost to follow up.

n=71

Variable Frequency(n) Percentage (%)

Clients always get support from family
members
No 45 63.4
Yes 26 36.6.
Get enough food while on treatment
No 61 85.9
Yes 10 14.1
How client feels after taking food on an
empty stomach
Vomiting 47 66.2
Abdominal pain 11 15.5
Diarrhea 8 11.3
Dizziness 5 7.0
Client feels like taking treatment when
lacking food
Yes 66 93
No 5 7.0
Sex of the clients affects their return
date
Yes 49 69
No 22 31

Source: Primary data 2018.

26
More than a quarter 45(63.4%) of the respondents reported no support from family

members and only 26(36.6%) could get family support from family members.

Majority 61(85.9%) of the respondents did not get enough food whereas only

10(14.1%) would getenough food while on treatment.

Majority 47(66.2%) reported vomiting when they take treatment on an empty

stomach, compared to 5(7.0%) who could get dizziness.

More than a half 66(93%) of respondents did not like taking treatment when lacking

food and only 5(7.0%) liked taking treatment while lacking food.

n=49

key
usally traval a lot
47%
53% Attending to domestic work

Source: Primary data 2018.

Figure 2 Showing reasons for clients whose return to the clinic was affected by

their sex.

Out of those who were affected by their sex, majority 26(53.1%) said that being

males, they usually travel alot looking for money to look after their families, while

23(46.9%) said that they have increased domestic work.

27
 n=71

KEY
40 Stage 1
49%
35 Stage 2
30
Stage 3
25 32%
Frequency

Stage 4
20
15
13%
10
6%
5
0
Stage 1 Stage 2 Stage 3 Stage 4
Variables

Source: primary data 2018

Figure 3 Showing the stage at which the client started treatment.

Majority 35(49.3%) of the respondents reported that they started ART treatment

while in stage 4, compared to 4(5.6%) who started ART treatment when they were in

stage I.

28
SECTION C; HEALTH FACILITY FACTORS

n=71

key
1 staff
2% 2-3 staff

29% 3-5 staff

40%

Source: Primary data 2018.

Figure 4 Showing number of staff met on duty during the clinic.

According to research results, more than a half 40(56.3%) of the respondents reported

2-3staff on duty during the clinic while only 2(2.8%) reported 3-5staff on duty during

the clinic.

29
Table (5) Showing respondents’ responses on health facility factors

n=71
Number of clients at the clinic Frequency(n) Percentage (%)
5-10 clients 10 14.1
10-15 clients 48 67.6
15-20 clients 8 11.3
Morethan 20 clients 5 7
Time taken while waiting for
treatment
1-2 hours 5 7
2-4 hours 21 29.6
4-6 hours 33 46.5
More than 6 hours 12 16.9
Attitude of health workers towards
clients
Good 65 91.5
Fair 6 8.5
Bad 0 0
I don’t know 0 0
Home Distance to the ART clinic
1/2km 4 5.6
1-2 km 12 16.9
2-3km 19 26.8
More than 3km 36 50.7
Time taken to reach the ART clinic
½-1hour 5 7
1-2 hours 12 16.9
2-3 hours 18 25.4
More than 3 hours 36 50.7
Cost of transport
1000-2000shs 3 4.2
2000-4000shs 6 8.5
5000-6000shs 22 31
Above 6000shs 40 56.3
Source: Primary data 2018.

30
Also majority 48 (67.8%) reported that they are approximately 10-15 clients on each

clinic day while less than a quarter 8(11.3%) of the respondents only reported 15-20

clients on each clinic day. Majority 33(46.5%) reported that they spend 4-6hours

while waiting for treatment whereas only 5(7%) reported that they take 1-2hours

while waiting for treatment. Almost all clients 65(91.5%) reported good attitude

towards them compared to 6(8.5%) who reported fair attitude towards them. Majority

36(50.7%) of the respondents also reported home distance of more than 3km and only

4(5.6%) reported home distance of 1/2km. More than a half 40(56.3%) reported cost

of transport being above 6000shs and only 3(4.2%) reported the cost of transport

between 1000-2000shs.

31
 CHAPTER FIVE.

DISCUSSION, CONCLUSION, NURSING IMPLICATION AND

RECOMMENDATION.

INTRODUCTION.

This chapter discusses the findings from the study about factors contributing to LTFU

of HIV positive clients and addresses the conclusion, nursing implication and the

recommendation from the study.

5.1. DISCUSSION.

5.1.1. CLIENT FACTORS.

Majority 62(87.3%) of the clients had ever missed their appointment return dates to

the clinic. This was due to factors like lack of money for transport 28(45.2%), long

distance 20 (32.3%) and other unavoidable environmental factors.

The study findings showed that stigma is a contributing factor to the lost to follow up

among HIV clients from the clinic. This is evidenced by 49(69%) of the respondents

who reported that they felt shy and stigmatized when they were seen by others as they

came to the clinic for treatment. This is probably due to unwillingness to disclose

their serostatus, as supported by 57(80.3%) of the respondents who were not willing

to disclose their status to anyone. This is in line with McGuire, et al, (2010) who

asserted that stigma related to HIV diminishes patient’s access to social capital-norms

32
of trust and reciprocity, an individual can access to solve day to day problem and also

impairs retention in care.

Fear of the side effects also hinders most clients to be retained in the care. This was

reported by 54(76.1%) of the clients who said had reacted on HIV treatment and

24(44.4%) out of them reported that they would first stop visiting the clinic for ART

treatment. This is not only in line with the Key Informant in the Key Informant

Interview Guide (KIIG) but also with MOH of Ethiopia (2010) which found that

majority of regimen substitution cases are due to adverse drug reactions, and patients

become concerned about side effects and the effectiveness of new medication,

causing them to seek other treatment options.

Lack of support from family members has made most HIV clients default from the

clinic, as reported by 45(63.4%) who revealed that they do not get any family

support. This has left most of the client fail to turn up to the clinic in trying to make

ends meet for their survival. This is probably these clients are regarded as useless by

their family members. This conquers with MOH/WHO (2010) report, which showed

that lack of family support contributed to clients withdraw from the ART clinic.

The study results further showed that lack of enough nutritional support hindered

clients from the clinic. Majority 61(85.9%) reported not getting enough food whileon

treatment, this is probably due to a compromised immunity as most of these clients

are not able to work hard and raise all that is necessary for their families.It is further

evidenced by 47(66.2%) of the respondents reporting vomiting after taking ART

treatment on an empty stomach. And majority 66(93%) reported not taking the

33
treatment while lacking food, in fear of the side effects. This is supported by

Guardian (2009) who explained that taking ART on an empty stomach was like

digesting razor blades, and thus many simply get lost from the clinic.

It was further discovered that sex had an influence on the lost to follow up, where by

49(69%) of the respondents said that they were affected by their sex, of the 49(69%)

who said were affected by their sex, majority 26(53.1%) were men and they gave

travalling alot as a reseaon.This is probably due to work-particularly in professions of

truck drivers, business, fishermen and migrant agricultural workers which conquers

very well with Largarde et al,(2016) who associated men’s lost to follow –up to

migratory labor pattern

The study further revealed that Stage of the disease affects lost to follow-up as

evidenced by majority 35(49.3%) 0f the respondents saying they started ART

treatment at stage 4 .This is in line withTezera Moshago B, et al, (2014) who found

that patients with advanced clinical stage (3 and 4) at entry were less likely to be lost

to follow-up.

5.1.2. HEALTH FACILITY FACTORS.

The study findings revealed that shortage of staff plays a part in letting clients default

from the clinic. This was supported by 40(56.3%) of the respondents who reported

meeting 2-3 staff on duty whenever they came to the clinic and 48(67.8%) of the

respondents reported an average of 10-15 clients on every visit. This therefore leaves

long waiting hours due to work over load, as reported by 33(46.5%) who reported 4-6

34
 waiting hours at the clinic. This is probably due to failure for the health unit

management to recruit more staff to the clinic. This is in agreement with Jogleckar N,

et al (2011), who asserted that increased work load as a result of low staff-client ratio,

long waiting hours has prompted most clients to abandon treatment, and get lost to

follow up.

The study findings revealed the long home distances to the health facility hinders the

routine turn up of clients for the ART clinic, as evidenced by 36(50.7%) of the

respondents reporting a home distance of more than 3km to the ART clinic and

40(56.3%) reported a transport cost of more than shs6000 which has always forced

them to come by foot to the clinic, which is too tiresome. This is probably limiting

especially when the financial status is poor to meet the transport costs and the clients’

condition worsens. This conquers with Luebbert J, et al, (2010), who in his study

reported that the most common reason cited by patients for defaulting was travelling

long distance.

5.2. CONCLUSION.

Basing on the study results discussed about the factors contributing to lost to follow

up of HIV clients, the following conclusions were drawn in line with the specific

objectives of the study and the literature review.

i) Stigma

ii) Fear of the unknown/drug side effects

35
iii) Lack of transpor/distance to the health facility

iv) Lack of family support

v) Lack of enough nutritional requirements

vi) Sex of the client.

vii) Shortage of staff

5.3. RECOMMENDATIONS

i) Health care team members are recommended to teach clients the good with disclosing

a positive living.

ii) Relatives to HIV clients are recommended to love their relatives living with HIV and

consider them as important and offer family support.

iii) Clients are encouraged to have small scale income generating activities for financial

support.

iv) Clients are recommended not to take ART treatment on an empty stomach.

v) The hospital administrationis should re-allocation staff to the HIV clinic especially

during clinic days, to avert work overload.

5.4. NURSING IMPLICATION.

Health workers are implication to hasten follow of HIV clients before they get lost to

follow up, which ould try to maintain clients in the clinic.

36
It also implicates health care givers to always support clients psychologically, socially

and instill hope for “tomorrow”.

FURTHER TOPIC OF STUDY

Adherence of HIV clients on ART treament

37
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42
APPENDICES
(I): CONSENT FORM

I am Atukwatse Mackline, a student of Kampala international University School of

nursing and midwifery Bushenyi district undertaking a diploma in nursing. I hereby

carry out a research on Factors contributing to lost- to follow- up among HIV positive

clients at Kakanju Health Centre III Bushenyi District You have been selected to

participate in the study in answering questions that are on the questionnaire. You have

a right to refuse if you feel you do not want to participate and your refusal does not

have any bad consequence on your part. The information you give will be kept

confidential. You are not required to write your name on the questionnaire.

There is no any direct benefit to you as you participate however; the results of the

study may benefit other people in future. If you have any question about the study,

please feel free to contact Atukwatse Mackline on 0779934210/0703611400. If you

have any question about your right as a result of participation, freely contact Mrs.

Sylvia, my research supervisor on 0702366326

Subject consent:

I understand that my decision to participate in the study will not alter my right and

that the information given will be used by Kampala international University School of

nursing and midwifery Bushenyi district. A copy of this form will be provided to me.

Participant’s signature

……………………………….

43
 APPENDIX II:A QUESTIONNAIRE FOR HIV/AIDS CLIENTS ABOUT

FACTORS THAT CONTRIBUTE TO LOST TO FOLLOW-UP AMONG HIV

CLIENTS AT KAKANJU H/CIII

Serial no: ………………………….Date: ………………………….…….

INTRODUCTION

I am Atukwatse Mackline, a diploma student nursing from Kampala international

School of Nursing and Midwifery carrying out a study on factors contributing to lost

to follow-up among HIV/AIDS clients.

By answering the following questions correctly you will have contributed greatly to

the identification of factors contributing to lost to follow-up among HIV/AIDS clients

at Kakanju H/CIII. Your name is not required on this paper and your information will

remain confidential.

SECTION A; RESPONDENT’S DEMOGRAGHIC DATA

1. Your age in years………………………………………..………

2. Sex: a).Female  b).Male 

3. Religion: a).Protestant  b).Catholic  c).Moslem 

d).Others: please specify.…………………………………………….

4. Marital status: a).Single b).Married 

c).Widow/widower  d).Separated /divorced 

5. Occupation: a).Peasant  b).Business

c).  Civil servant  d).Others (specify) ……………

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6. Formal education.

a).None  b).P.1-P7  c).S.1-S.4 

d).S.5-S.6  e).Tertially 

SECTION B; CLIENT FACTORS ATTRIBUTING TO LOST TO FOLLOW-

UP

1.Have you ever missed your appointment date of return to the clinic?

a).Yes b) No

2. What is your reason(s) for any response above?.............................................

…………………………………………………………………………………..

………………………………………………………………………………….

3. How do you feel when others see you come for HIV treatment at the clinic?

a).Shy and stigmatized b).Guilty and unhappy

c) Free d).Others……………………

4. Do you feel like disclosing your HIVstatus to others?

a).Yes b) No

5. Have you ever reacted on HIV treatment?

a) Yes b) No

6. If yes, what would be your response?

a).Stop treatment b).Stop visiting the clinic for treatment

c).Continue with treatment d).seek other treatment options

e).Others specify…………………………..

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7. Does your family members always support you throughout your sickness?

a) Yes b) No

8. Do you get enough food while on treatment?

a).Yes b).No

9. How do you feel when take ART on an empty stomach?

a).Diarrhea b).Abdominal pain

c).Vomiting d).Dizziness

e).others…………………………………………………………………

10. When you lack food, do you feel like taking and seeking ART treatment?

a) Yes b) No

11. Does your sex affect your return to the clinic

a).Yes b).No

12. If yes how give (reasons)……………………………………………….

……………………………………………………………………………

……………………………………………………………………………

13. At what stage did you start ART treatment?..

a) Stage i b) Stage ii

c) Stage iii d) Stage iv

SECTION C; HEALTH FACILITY FACTORS

1. How many staff do you always meet on duty when you visit the clinic?

a) 1 staff b) 2-3 staff c) 3-5 staff d) Above 5 staff

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2. Approximately how many of you are always at the clinic?

a) 5-10 clients b) 10-15 clients

c)15-20 clients d) More than 20 clients

3. For how long have always waited for treatment?

a) 1-2 hours b) 2-4 hours c) 4-6 hours d) More than 6 hours

4. What is the attitude of health workers towards you?

a) Good b) Fair c) Bad d) I don’t know

5. How far is your home your ART clinic?

a) 1/2km b) 1-2km c) 2-3km d) More than 3km

7. How long does it take you to reach the ART clinic?

a) 1/2-1 hour b) 1-2 hours c) 2-3 hours d) More than 3 hours

8. In case you transport yourself to and from the clinic, how much does it cost

you?

a) 1000-2000 shs b) 2000-4000shs

c) 4000-6000shs d) above 6000shs

END

Thank you

47
APPENDIIX; III A QUESTIONNAIRE FOR HEALTH WORKERS ABOUT

FACTORS THAT CONTRIBUTE TO LOST TO FOLLOW-UP AMONG HIV

CLIENTS.

Iam Atukwatse Mackline, a diploma student nurse from kampala International

University School of Nursing and Midwifery carrying out a research on factors

contributing to lost to follow-up among HIV clients.

This questionnaire therefore aims to collect information from you to enable the study.

Be free to contribute and answer the following questions. Your answers shall be

treated with maximum confidentiality.

Date of data collection.................................................................................

Respondent’s code no..................................................................................

SECTION A; DEMOGRAGHIC DATA

1.Age

a)20-25years b) 25-30 years c) 30-35 years

d) Above 35 years

2.Sex

a) Male b) Female

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3.Cadre

a) Nursing assistant b) Consellor d) Enrolled nurse

c) Nursing officer e) Dispenser f) VCTs

SECTION B; CLIENT FACTORS.

1.Do some clients get lost from the clinic?

a) Yes b) No

2.If yes, why? Tick all that apply

a) Long distance

b) Death

c) Transport cost

d) Pregnancy

e) Fear of drug side effects

f) Stage 3 or 4 of the disease

3.On the attendance of clients to the clinic, do clients with lower CD4 cell count

consistently turn-up for treatment?

a) Yes b) No

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4.Which sex of clients normally have poor turn-up to the clinic on the appointed

dates?

a) Males b) Females

5.Which age group has always missed to return to the clinic?

a) 2-10 years b) 10-15 years c) 15-25 years

d) 25 years and above

SECTION C; HEALTH FACILITY FACTORS

1.How many staff are always on a shift per day?

a) 1-2 staff b) 2-3 staff c) 3 staff and above

2.How many clients do you approximately receive on ART clinic day?

a) 5-10 b) 10-15 c)15-20 d)

Above 20

3.How does the number of clients received per clinic affect your services rendered?

..........................................................................................................................................
..........................................................................................................................................
..........................................................................................................................................

4.Do you think HIV patients are responsible for thier illiness?

a) Yes c) No

END

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APPENDIIX; IV INTRODUCTORY LETER

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APPENDIX V: A MAP OF UGANDA SHOWING BUSHENYI DISTRICT

KEY: BUSHENYI DSTRICT

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APPENDIX VI: AMAP OF BUSHENYI DISTRICT SHOWING

KAKANJUH/CIII

KEY KAKANJU H/CIII

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