Socio-Clinical profile of Defaulters from Pre ART Care under Routine Program Conditions in North India– A Cross Sectional Study

INTRODUCTION:  In India, about 1.4 million patients registered in HIV care & 40 per cent of them are in pre ART care. High rate of default during Pre ART care especially in less advanced clinical stage   is a growing concern for the National Program. In order to implement desired intervention to reduce the default in this period, the assessment of socio - clinical profile & investigation of reasons are necessary.

METHODS: The study was conducted between May 2012 to June 2013 at ART centre, COE, Banaras Hindu University (BHU), Varanasi. A list of defaulters was prepared & traced telephonically by the counsellors & outreach workers from the last contact number. Patients who returned after default and gave their consent were clinically assessed & interviewed for reasons of default.  

RESULTS: 60 were interviewed out of the total (84) traced defaulters.  Half of them were in the age group < 30 years, two- third were females & three- fourth belong to rural area. Majority (85%) of them were out of employment at the time of interview. 63.3% defaulted between 6 to 12 months of program inclusion.  There was deterioration in WHO Clinical staging of about one-third patients after default Functional status also changed from working condition to ambulatory/ bed ridden in 10 % defaulters. Most cited reasons were inconvenient clinic timings (88%), need of multiple transport (77%) compounded with perceived improved health (52.3%) .

 CONCLUSIONS: Default during Pre ART period needs more emphasis as there was deterioration in WHO clinical staging & functional status after default. Outreach work is required to retrieve defaulters.