{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,2]],"date-time":"2025-08-02T19:46:19Z","timestamp":1754163979605,"version":"3.41.2"},"reference-count":51,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2025,7,31]],"date-time":"2025-07-31T00:00:00Z","timestamp":1753920000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>Antiretroviral therapy (ART) defaulting is a serious problem among youth accessing Human immunodeficiency virus (HIV) care services in Malawi. It leads to development of drug resistance, treatment failure and increased client mortality. This study aimed at assessing patient factors influencing ART defaulting amongst youth living with HIV enrolled on ART in Mzimba District. A quantitative, case-control design was employed, enrolling 411 youths living with HIV (n\u2009=\u2009137 cases and n\u2009=\u2009274 controls) attending an HIV care clinic. The cases and controls were allotted to the ART clinics proportionally to their number of ART clients. Random sampling techniques were used to recruit both ART defaulters and non-defaulters. Data were collected using a structured questionnaire and analyzed using Statistical Package for Social Sciences (SPSS) version 20.0. Descriptive statistics provided counts, frequencies, proportions, and ranges, while inferential statistics established associations between dependent and independent variables. Patient related factors associated with ART defaulting include: Participants age (p-value: 0.046, Cramer\u2019s V: 0.2, OR: 0.663, 95% CI: 0.439\u20130.902), forgetting appointment date (p-value:\u2009&lt;\u20090.001, OR: 4.213, 95% CL: 2.289-7.755), experiencing ART side effects (p-value:\u2009&lt;\u20090.001, OR: 0.438, 95% CL: 0.286-0.672), taking other drugs apart from ART (p-value 0.008, OR: 0.059, 95% CL: 0.007-0.479). ART defaulting was also associated with presence of a psychological disorder among the participants (SRQ statement 7_8) (p-value &lt;0.001, OR: 22.119, 95% CL: 10.81-45.26) and having suicidal ideas (p-value &lt;0.001, OR: 0.111, 95%CL: 0.051-0.241). Seventeen percent (17%) of the youths had psychological disorders, 10% suicidal thoughts, 20.0% anxiety, 12.4% felt worthless, 19.2% troubled mind, 24.8% headache and abdominal discomfort (23.8%). This study sought to identify patient factors associated with ART defaulting in Mzimba district. Participant\u2019s age, forgetfulness, ART side effects, taking other drugs and having psychological disorders influence ART defaulting. We recommend that addressing these patient needs, may reduce defaulting to ART.<\/jats:p>","DOI":"10.1371\/journal.pgph.0004507","type":"journal-article","created":{"date-parts":[[2025,7,31]],"date-time":"2025-07-31T17:48:02Z","timestamp":1753984082000},"page":"e0004507","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Patient related factors associated with antiretroviral therapy defaulting among the youth accessing HIV care services in Mzimba, Malawi"],"prefix":"10.1371","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-1993-020X","authenticated-orcid":true,"given":"Paul Isaac","family":"Kasalu","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthews","family":"Lazaro","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Idesi","family":"Chilinda","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,7,31]]},"reference":[{"key":"pgph.0004507.ref001","unstructured":"UNAIDS. Understanding measures of progress towards the 95\u201395\u201395 HIV testing, treatment and viral suppression targets | UNAIDS [Internet]. 2024 [cited 2025 Mar 23]. Available from: https:\/\/www.unaids.org\/en\/resources\/documents\/2024\/progress-towards-95-95-95"},{"key":"pgph.0004507.ref002","unstructured":"UNAIDS. The Joint United Nations Programme on HIV\/AIDS. All In to #EndAdolescentAIDS [Internet]. 2015. Available from: http:\/\/www.unaids.org\/sites\/default\/files\/media_asset\/20150217_ALL_IN_brochure.pdf"},{"issue":"05","key":"pgph.0004507.ref003","doi-asserted-by":"crossref","first-page":"340","DOI":"10.4236\/jbm.2024.125026","article-title":"Factors Associated with Antiretroviral Therapy Defaulting among Adult Patients Receiving Care at Chikankata Mission Hospital, Chikankata District, Zambia","volume":"12","author":"F Paundi","year":"2024","journal-title":"JBM"},{"issue":"03","key":"pgph.0004507.ref004","doi-asserted-by":"crossref","first-page":"51","DOI":"10.4236\/arsci.2019.73007","article-title":"Pregnancy Outcomes at Kasungu Maternity Ward in Central Malawi\u2014A Review of Maternity Ward Register","volume":"07","author":"JH Park","year":"2019","journal-title":"ARSci"},{"issue":"1","key":"pgph.0004507.ref005","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1186\/s12889-021-10527-z","article-title":"Common mental disorders and HIV status in the context of DREAMS among adolescent girls and young women in rural KwaZulu-Natal, South Africa","volume":"21","author":"N Mthiyane","year":"2021","journal-title":"BMC Public Health"},{"volume-title":"The Malawi guidelines for clinical management of HIV in children and adults","year":"2016","author":"Ministry of Health","key":"pgph.0004507.ref006"},{"key":"pgph.0004507.ref007","unstructured":"World Health Organization. Fact Sheet: HIV Drug Resistance [Internet]. 2022 [cited 2023 Nov 29]. Available from: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/hiv-drug-resistance"},{"issue":"2","key":"pgph.0004507.ref008","article-title":"Why Did I Stop? Barriers and Facilitators to Uptake and Adherence to ART in Option B+ HIV Care in Lilongwe, Malawi","volume":"11","author":"MH Kim","year":"2016","journal-title":"PLoS One"},{"issue":"2","key":"pgph.0004507.ref009","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0191848","article-title":"Adherence to antiretroviral therapy in a clinical cohort of HIV-infected children in East Africa","volume":"13","author":"RC Vreeman","year":"2018","journal-title":"PLoS One"},{"issue":"4","key":"pgph.0004507.ref010","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1080\/09540121.2015.1110234","article-title":"Loss to follow-up among youth accessing outpatient HIV care and treatment services in Kisumu, Kenya","volume":"28","author":"VO Ojwang\u2019","year":"2016","journal-title":"AIDS Care"},{"issue":"1","key":"pgph.0004507.ref011","doi-asserted-by":"crossref","DOI":"10.1097\/QAI.0000000000000863","article-title":"Implementation and Operational Research: Community-Based Adherence Clubs for the Management of Stable Antiretroviral Therapy Patients in Cape Town, South Africa: A Cohort Study","volume":"71","author":"A Grimsrud","year":"2016","journal-title":"J Acquir Immune Defic Syndr"},{"key":"pgph.0004507.ref012","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1186\/s12981-016-0110-2","article-title":"Determinants of time to antiretroviral treatment initiation and subsequent mortality on treatment in a cohort in rural northern Malawi","volume":"13","author":"JP Brown","year":"2016","journal-title":"AIDS Res Ther"},{"issue":"7","key":"pgph.0004507.ref013","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0101875","article-title":"Follow-Up Visit Patterns in an Antiretroviral Therapy (ART) programme in Zomba, Malawi","volume":"9","author":"B Rachlis","year":"2014","journal-title":"PLoS One"},{"key":"pgph.0004507.ref014","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1111\/j.1365-3156.2010.02504.x","article-title":"Vital status of pre\u2010ART and ART patients defaulting from care in rural Malawi","volume":"15","author":"M McGuire","year":"2010","journal-title":"Tropical Medicine & International Health"},{"key":"pgph.0004507.ref015","unstructured":"Mwale J. Mzimba registers 30% ART default rate \u2013 The Nation Online [Internet]. 2016 [cited 2019 Sep 2]. Available from: https:\/\/mwnation.com\/mzimba-registers-30-art-default-rate\/"},{"volume-title":"Mzimba district ART monthly report, May 2019","year":"2019","author":"HMIS Data","key":"pgph.0004507.ref016"},{"issue":"2","key":"pgph.0004507.ref017","doi-asserted-by":"crossref","first-page":"121","DOI":"10.4103\/0253-7176.116232","article-title":"How to Calculate Sample Size for Different Study Designs in Medical Research?","volume":"35","author":"J Charan","year":"2013","journal-title":"Indian J Psychol Med"},{"issue":"1","key":"pgph.0004507.ref018","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1186\/s12865-018-0278-4","article-title":"Prevalence and associated factors of treatment failure among HIV\/AIDS patients on HAART attending University of Gondar Referral Hospital Northwest Ethiopia","volume":"19","author":"G Ayele","year":"2018","journal-title":"BMC Immunol"},{"issue":"1","key":"pgph.0004507.ref019","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1186\/s12879-018-3087-8","article-title":"Factors affecting adherence to antiretroviral therapy among pregnant women in the Eastern Cape, South Africa","volume":"18","author":"OV Adeniyi","year":"2018","journal-title":"BMC Infect Dis"},{"issue":"7","key":"pgph.0004507.ref020","doi-asserted-by":"crossref","first-page":"1199","DOI":"10.1007\/s10461-014-0729-8","article-title":"Impact of geographic and transportation-related barriers on HIV outcomes in sub-Saharan Africa: a systematic review","volume":"18","author":"AJ Lankowski","year":"2014","journal-title":"AIDS Behav"},{"issue":"1","key":"pgph.0004507.ref021","doi-asserted-by":"crossref","first-page":"1545","DOI":"10.1186\/s12889-020-09652-y","article-title":"Does distance from a clinic and poverty impact visit adherence for noncommunicable diseases? A retrospective cohort study using electronic medical records in rural Haiti","volume":"20","author":"LD Yan","year":"2020","journal-title":"BMC Public Health"},{"volume-title":"Peer Pressure and Adolescents\u2019 Problem Behavior [Internet]","year":"2020","author":"T Bandzeladze","key":"pgph.0004507.ref022"},{"key":"pgph.0004507.ref023","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1080\/00221325.2019.1621259","article-title":"Associations Between Peer Pressure and Adolescents\u2019 Binge Behaviors: The Role of Basic Needs and Coping","volume":"180","author":"C Inguglia","year":"2019","journal-title":"J Genet Psychol"},{"issue":"3","key":"pgph.0004507.ref024","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1016\/S2352-4642(18)30022-1","article-title":"The age of adolescence","volume":"2","author":"SM Sawyer","year":"2018","journal-title":"Lancet Child Adolesc Health"},{"issue":"10036","key":"pgph.0004507.ref025","doi-asserted-by":"crossref","first-page":"2423","DOI":"10.1016\/S0140-6736(16)00579-1","article-title":"Our future: a Lancet commission on adolescent health and wellbeing","volume":"387","author":"GC Patton","year":"2016","journal-title":"Lancet"},{"issue":"1","key":"pgph.0004507.ref026","doi-asserted-by":"crossref","first-page":"456","DOI":"10.4314\/ahs.v22i1.54","article-title":"Factors affecting adherence to anti-retroviral therapy among women attending HIV clinic of a tertiary health institution in SouthEastern, Nigeria","volume":"22","author":"HC Opara","year":"2022","journal-title":"Afr Health Sci"},{"key":"pgph.0004507.ref027","doi-asserted-by":"crossref","first-page":"1148","DOI":"10.1186\/s12913-022-08527-9","article-title":"Impact of low health literacy on patients\u2019 health outcomes: a multicenter cohort study","volume":"22","author":"R Shahid","year":"2022","journal-title":"BMC Health Services Research"},{"issue":"4","key":"pgph.0004507.ref028","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1016\/j.amjms.2016.07.003","article-title":"Missed Appointments in a Breast Clinic: Patient-Related Factors","volume":"352","author":"JB Knolhoff","year":"2016","journal-title":"Am J Med Sci"},{"issue":"5","key":"pgph.0004507.ref029","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1080\/20009666.2020.1796903","article-title":"Patients\u2019 reasons for missing scheduled clinic appointments and their solutions at a major urban-based academic medical center","volume":"10","author":"MF Alkomos","year":"2020","journal-title":"J Community Hosp Intern Med Perspect"},{"issue":"6","key":"pgph.0004507.ref030","doi-asserted-by":"crossref","first-page":"956","DOI":"10.1017\/S1355617711000968","article-title":"Does antiretroviral therapy improve HIV-associated cognitive impairment? A quantitative review of the literature","volume":"17","author":"T Al-Khindi","year":"2011","journal-title":"J Int Neuropsychol Soc"},{"key":"pgph.0004507.ref031","doi-asserted-by":"crossref","DOI":"10.1016\/j.jana.2012.03.006","article-title":"Assessing and treating forgetfulness and cognitive problems in adults with HIV","volume":"24","author":"DE Vance","year":"2013","journal-title":"J Assoc Nurses AIDS Care"},{"key":"pgph.0004507.ref032","first-page":"96","article-title":"Experiences of relatives caring for family members who attend antiretroviral therapy clinic at a teaching hospital in Limpopo Province, South Africa","volume":"19","author":"TM Mothiba","year":"2013","journal-title":"African Journal for Physical Activity and Health Sciences"},{"key":"pgph.0004507.ref033","doi-asserted-by":"crossref","DOI":"10.3389\/fpubh.2024.1374515","article-title":"Incidence and predictors of loss to follow-up among adult patients receiving antiretroviral therapy in Central Ethiopia: a multi-center retrospective cohort study","author":"A Anulo","year":"2024","journal-title":"Front Public Health"},{"key":"pgph.0004507.ref034","doi-asserted-by":"crossref","first-page":"1897","DOI":"10.2147\/PPA.S141762","article-title":"Highly specific reasons for nonadherence to antiretroviral therapy: results from the German adherence study","volume":"11","author":"J Boretzki","year":"2017","journal-title":"Patient Preference and Adherence"},{"key":"pgph.0004507.ref035","doi-asserted-by":"crossref","DOI":"10.1136\/sextrans-2016-052971","article-title":"\u2018Side effects\u2019 are \u2018central effects\u2019 that challenge retention in HIV treatment programmes in six sub-Saharan African countries: a multicountry qualitative study","volume":"93","author":"J Renju","year":"2017","journal-title":"Sex Transm Infect"},{"issue":"1","key":"pgph.0004507.ref036","doi-asserted-by":"crossref","first-page":"1382","DOI":"10.1186\/s12889-019-7768-z","article-title":"Factors influencing adherence to antiretroviral treatment among adults accessing care from private health facilities in Malawi","volume":"19","author":"L Chirambo","year":"2019","journal-title":"BMC Public Health"},{"key":"pgph.0004507.ref037","first-page":"125","article-title":"Evaluation of cotrimoxazole use as a preventive therapy among patients living with HIV\/AIDS in Gondar University Referral Hospital, northwestern Ethiopia: a retrospective cross-sectional study","volume":"8","author":"BM Gebresillassie","year":"2016","journal-title":"HIV AIDS"},{"issue":"3","key":"pgph.0004507.ref038","doi-asserted-by":"crossref","first-page":"826","DOI":"10.1007\/s10461-020-03041-7","article-title":"Association between depression and HIV care engagement outcomes among patients newly initiating ART in Lilongwe, Malawi","volume":"25","author":"MA Stockton","year":"2021","journal-title":"AIDS Behav"},{"issue":"3","key":"pgph.0004507.ref039","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1176\/appi.neuropsych.12110268","article-title":"Toward an understanding of decision making in severe mental illness","volume":"26","author":"R C\u00e1ceda","year":"2014","journal-title":"J Neuropsychiatry Clin Neurosci"},{"issue":"1","key":"pgph.0004507.ref040","doi-asserted-by":"crossref","first-page":"827","DOI":"10.1186\/s12889-019-7132-3","article-title":"The effectiveness of depression management for improving HIV care outcomes in Malawi: protocol for a quasi-experimental study","volume":"19","author":"M Udedi","year":"2019","journal-title":"BMC Public Health"},{"issue":"1","key":"pgph.0004507.ref041","doi-asserted-by":"crossref","first-page":"20049","DOI":"10.7448\/IAS.18.1.20049","article-title":"Contemporary issues on the epidemiology and antiretroviral adherence of HIV-infected adolescents in sub-Saharan Africa: a narrative review","volume":"18","author":"OA Adejumo","year":"2015","journal-title":"J Int AIDS Soc"},{"issue":"9","key":"pgph.0004507.ref042","doi-asserted-by":"crossref","first-page":"2514","DOI":"10.1007\/s10461-019-02670-x","article-title":"A Qualitative Study to Identify Perceptual Barriers to Antiretroviral Therapy (ART) Uptake and Adherence in HIV Positive People from UK Black African and Caribbean Communities","volume":"23","author":"E Glendinning","year":"2019","journal-title":"AIDS Behav"},{"key":"pgph.0004507.ref043","doi-asserted-by":"crossref","first-page":"259","DOI":"10.2147\/HIV.S459124","article-title":"Health system responses to address treatment gaps of unsuppressed adolescents on HIV treatment in public primary health care facilities in Windhoek, Namibia","volume":"16","author":"FK Munyayi","year":"2024","journal-title":"HIV"},{"issue":"1","key":"pgph.0004507.ref044","doi-asserted-by":"crossref","first-page":"1450","DOI":"10.1186\/s12889-025-22579-6","article-title":"Experiences and perceptions on antiretroviral therapy adherence and non-adherence: a scoping review of young people living with HIV in sub-Saharan Africa","volume":"25","author":"TC Seunanden","year":"2025","journal-title":"BMC Public Health"},{"issue":"1","key":"pgph.0004507.ref045","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0169651","article-title":"Discontinuation from Antiretroviral Therapy: A Continuing Challenge among Adults in HIV Care in Ethiopia: A Systematic Review and Meta-Analysis","volume":"12","author":"HA Gesesew","year":"2017","journal-title":"PLoS One"},{"issue":"1","key":"pgph.0004507.ref046","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1186\/s40359-023-01177-4","article-title":"Suicidal ideation of people living with HIV and its relations to depression, anxiety and social support","volume":"11","author":"Y Yu","year":"2023","journal-title":"BMC Psychol"},{"key":"pgph.0004507.ref047","doi-asserted-by":"crossref","first-page":"111","DOI":"10.2147\/HIV.S129992","article-title":"The social stigma of HIV\u2013AIDS: society\u2019s role","volume":"9","author":"EN Kontomanolis","year":"2017","journal-title":"HIV\/AIDS - Research and Palliative Care"},{"key":"pgph.0004507.ref048","unstructured":"Pebody R. HIV treatment side-effects and mental health [Internet]. aidsmap.com. 2023 [cited 2024 Sep 16]. Available from: https:\/\/www.aidsmap.com\/about-hiv\/hiv-treatment-side-effects-and-mental-health"},{"issue":"1","key":"pgph.0004507.ref049","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1007\/s11481-021-09987-2","article-title":"Effects of Antiretroviral Therapy in the Central Nervous System: Beyond Viral Suppression","volume":"16","author":"KL Jordan-Sciutto","year":"2021","journal-title":"J Neuroimmune Pharmacol"},{"issue":"1","key":"pgph.0004507.ref050","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1186\/s12982-025-00601-x","article-title":"The burden and associated social determinants of mental health among adolescent girls and young women in Sub-Saharan Africa","volume":"22","author":"ED Perestrelo","year":"2025","journal-title":"Discov Public Health"},{"issue":"6","key":"pgph.0004507.ref051","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1097\/COH.0000000000000877","article-title":"Neuroinflammation and mental health outcomes in adolescents living with HIV","volume":"19","author":"A Mudra Rakshasa-Loots","year":"2024","journal-title":"Curr Opin HIV AIDS"}],"container-title":["PLOS Global Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0004507","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,31]],"date-time":"2025-07-31T17:48:10Z","timestamp":1753984090000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0004507"}},"subtitle":[],"editor":[{"given":"Marie A.","family":"Brault","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2025,7,31]]},"references-count":51,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2025,7,31]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pgph.0004507","relation":{},"ISSN":["2767-3375"],"issn-type":[{"type":"electronic","value":"2767-3375"}],"subject":[],"published":{"date-parts":[[2025,7,31]]}}}