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Mobility and ART retention among men in Malawi: a mixed-methods study
Marguerite Thorp1, MacDaphton Bellos2, Tijana Temelkovska3
1Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, California, USA.
Journal of the International AIDS Society
|March 21, 2023
Summary
Mobility for income generation disrupts HIV care for men in Malawi, leading to treatment interruptions. Flexible health systems and multi-month dispensing are crucial for retaining mobile men in care.
Area of Science:
- Public Health
- Epidemiology
- Social Sciences
Background:
- Mobility is linked to poorer HIV treatment outcomes, particularly for men.
- Mechanisms connecting mobility and HIV care interruptions remain under-researched in Southern Africa.
Purpose of the Study:
- To investigate the relationship between mobility and HIV treatment interruptions among men living with HIV (MLHIV) in Malawi.
- To identify specific types of mobility and associated factors that increase the risk of ART interruption.
Main Methods:
- A mixed-methods study combining survey data from 223 mobile MLHIV with in-depth interviews of 32 participants.
- Analysis included descriptive statistics, negative binomial regressions for quantitative data, and constant comparative methods for qualitative data.
Main Results:
- 34% of men with treatment interruptions were mobile, with a median of 60 nights away from home.
- Increased nights away and fewer assets correlated with longer periods out of care.
- Men faced challenges with unplanned travel, employer demands, accessing care, and ART refills, despite efforts to stay in care.
Conclusions:
- Mobility for livelihood conflicts with ART retention due to health system inflexibility.
- Men balance health needs with family support, highlighting the importance of understanding these trade-offs.
- Recommendations include enhanced counseling, peer support, nationwide ART access, and multi-month dispensing (MMD).
