This section represents respondent’s socio-demographic data which include gender, sex, marital status, religion, employment status and level of education for HIV clients on ART at Chikankata Mission Hospital ART Clinic (Table 1).

Table 1 presents a table with frequency and percentages on Socio-Demo- graphic Characteristics of patients at Chikankata Mission Hospital ART Clinic. The study assessed 385 participants on socio-demographical factors contributing to HIV clients defaulting on ART and the above table presents results on frequency and percentages. Table 1 shows (60.5%, n = 223) of study participants were female. For age, (40.5%, n = 156) of study participants were between 40 and 49 years old and majority (55.3%, n = 233) of study participants were married. More than half (67.0%, n = 258) of study participants had gone up to primary school level. Majority (72.2%, n = 280) of study participants were unemployed and on the religion all the participants were Christians (100%, n = 385). Majority (71.9%, n = 277) of study participants had an estimated monthly income of less than K100.

This section presents the information on the individual factors that includes transport costs and attitude of the participants towards ART services Chikankata Mission Hospital ART clinic. Attitude of people living with HIV towards ART services at Chikankata Mission Hospital ART Clinic include action taken by client when experiencing any adverse effects of ARVs, action taken by clients when no transport money to the health and importance of going for ART services all the time (Table 2).

Table 2 presents a table with frequency and percentages at Chikankata Mission Hospital ART Clinic on transport costs to the healthcare facility where participants received their ART services and attitude of PLWHA towards ART services (action taken when experiencing any of adverse effects of ARVs, action taken when there is no transport money to go for ART services and importance of going for ART services all the time). On transport costs to the health facility was expensive for most participants (70.40%, n = 271). Majority (71.9%, n = 276) of study participants returned to the ART clinic when experienced adverse effects of ARV while (68.3%, n = 263) of study participants informed the ART clinic when they did not have transport money for their ART services.

This section presents data on interpersonal factors on family support towards ART services at Chikankata Mission Hospital ART Clinic (Table 3).

Table 3 presents a table with frequency and percentages at Chikankata Mission Hospital ART Clinic on family support on HIV clients towards ART services to prevent defaulting on ART at Chikankata Mission ART clinic. Table 3 illustrates that less than half (48.6%, n = 187) had poor family support while as little as (17.4%, n = 67) hand excellent family support.

This section presents the institutional factors such as time taken by HIV clients to receive ART services and perceived attitude of health workers towards HIV clients at Chikankata Mission Hospital ART Clinic. Perceived attitude of health workers by HIV clients include: perceived reception by the health workers, pharmacist and nurses being rude on duty when HIV clients are accessing ART services. This section also presents results on health workers treating HIV clients with respect and provision of quality ART services perceived by HIV clients at Chikankata Mission Hospital ART clinic (Table 4).

Table 4 presents a table with frequency and percentages on time taken to be attended to at ART clinic and perceived attitude of health worker by clients at ART Clinic (perceived reception by the health workers at the ART clinic, pharmacists and nurses being rude on duty, health workers treating HIV patients

with respect at the ART clinic and perceived quality of ART services at Chikankata Mission Hospital ART clinic). On waiting time at the health facility more than three quarters (85.7%, n = 330) of the study participant had to wait for more than 45 minutes to receive ART services at Chikankata Mission Hospital’s ART clinic. On perceived attitude of Health Worker by clients at ART Clinic participants were asked how they felt about the reception they received from the health workers at the ART clinic when using their ART services and (56.6%, n = 218) of study participants described the services as good. Table 4 also indicated (82.8%, n = 319) of study participants disagreed that the pharmacists on duty were rude to them, (81.3%, n = 313) of study participants disagreed that the nurses on duty were rude. Over half (70.4%, n = 271) of study participants agreed that staff treated them with respect when receiving ART services at their clinic. Majority (58.7%, n = 226) of the study participants rated the establishment of ART services at Chikankata Mission Hospital’s ART Clinic as good.

This section presents data on the distance covered by people living with HIV when coming for ART services, perceived family/community support on people living with HIV on ART and perceived community treatment (societal stigma) on HIV clients on ART at Chikankata Mission Hospital ART Clinic (Table 5).

Table 5 outlines the findings on the table with frequencies and percentages on distance to the health facility, family support and perceived community treatment (societal stigma) on HIV clients at Chikankata Mission Hospital ART clinic. More than three quarters (76.1%, n = 293) of study participants stayed more than 10 km away from the health facility. On family member know the HIV status

of their HIV client (65.2%, n = 148) of study participants indicated that relatives and partners knew that they were on ART. Half (52.2%, n = 200) of study participants were treated well by the community upon knowing that they were HIV positive.

This section presents results on the prevalence of HIV clients defaulting on ART and reasons for defaulting on ART at Chikankata Mission Hospital ART Clinic. Among the reasons presented include: perceived improved health, self-stigma and mobility (Table 6).

Table 6 shows frequency and percentage of HIV clients defaulting from antiretroviral therapy and reasons for HIV clients defaulting on ART (perceived improved health, self-stigma and mobility) at Chikankata Mission Hospital ART clinic. This table shows (58.4%, n = 225) of study participants had previously defaulted on ART at Chikankata Mission Hospital ART clinic. Majority (65.8%, n = 148) of study participants indicated that their health had improved.

This section presents results on logistic regression analysis at both univariate and multivariable levels. All the independent variables were included in the model regardless of the significance level (Table 7).

Univariate and backward multivariable logistic regression analysis was performed to identify significant factors associated with defaulting from antiretroviral therapy among adult patients. Results from the univariate analysis show that transport cost, family Support, waiting time, distance to ART clinic, action when experiencing adverse effects, action when no transport money, important of going for ART services and perceived reception by the health workers at the ART clinic were associated with defaulting on ART among participants (p < 0.05).

cOR = Crude Odds Ratio, aOR = Adjusted Odds Ratio, CI = Confidence interval.

After adjusting for other variables, adults who informed the ART clinic when they had no money for transport were 0.47 times less likely to default on ART than adults who simply stayed at home when they had no money for transport (AOR 0.47; 95% CI: [0.27 - 0.82], p = 0.007). Adults who thought it was somewhat important to always go to ART services were 1.95 times more likely to default on ART than adults who thought it was very important to always go to ART services (AOR 1.95; 95% CI: [1.14 - 3.33], p = 0.015). Participants who reported poor family support for ART services were 4.08 times more likely to default on ART compared with those who reported excellent family support for ART services (AOR 4.08; 95% CI: [2.02 - 8.23], p < 0.001). In addition, participants who reported taking more than 45 minutes to be seen at the ART clinic were 2.08 times more likely to default on ART than those who were seen within 45 minutes (AOR 2.08; 95% CI: [1.06 - 4.07], p = 0.032) (Table 7).

This study revealed that women made up the majority of the study participants on ART defaulting among adult HIV patients receiving care at Chikankata Mission Hospital ART clinic. Out of 385 participants (60.5%, n = 233) were women while (39.5%, n = 152) were men. These findings are similar with studies conducted in different parts of the world. For instance, Stephen et al. (2021) [5] conducted a study on defaulting from antiretroviral therapy and their prevention in Nigeria and found that the majority of the respondents in their study were women while the minority were males. Another study by Mekonnen, N. et al. (2019) [6] in Ethiopia on Incidence and predictors of lost to follow up among HIV infected (HIV patients defaulting on ART) revealed that out of 569 participants (60.1%, n = 324) were females while (43.1%, n = 245) were males. Another similar research conducted by Kalayu, G. and Tomas, Z. (2021) [7] in Ethiopia on Antiretroviral Therapy Default and Associated Factors among PLWHA revealed that (54%, n = 130) were females while (46%, n = 130) were males. However, these findings revealed contradict those of another Chinese study which found that males made up the majority of study participants. Liao, B. et al. [8] conducted a study on Analysis of factors associated with dropping-out from HIV antiretroviral therapy (Defaulting on ART). The study showed that out of total 439 participants (75%, n = 189) were males while (25%, n = 63) were females. These disparities in the results could be due to population where there are more males than females in China.

This study revealed that (7.8%, n = 30) of study participants were in the age range of 20 - 29 years old, (20.5%, n = 79) were in the age range of 30 - 39 years old, (40.5%, n = 156) of study participants were in the age range of 40 - 49 years old and (31.2%, n = 120) of study participants were above 50 years old. Therefore, this study showed that the majority of study participants were in the range of 40 - 49 years old. Contrary to the study by Ayele, G. et al. [8] China on Analysis of factors associated with dropping-out from HIV antiretroviral therapy (Defaulting on ART) which showed that out of 451 participants, 63.3% were young than 35 year old. Another study by Ayele, G. et al. [9] Ethiopia on Prevalence and associated factors of treatment failure and Defaulting among HIV AND AIDS Patients showed that out of a total 423 participants, 169 (40%) were within the age of 30 - 39 years old. The discrepancy in the age distribution could be attributed to differences in sample cultural and regional differences in the populations being studied. This study revealed more than half (55.3%, n = 213) of the study participants were married while a smaller percentage (17.1% n = 16) of study participants were single, (14.3%, n = 55) of study participants were divorced, (13.2%, n = 51) of study participants were widowed. This is in line with the findings of a similar studies conducted by Mpinganjira, S. et al. [10] on factors associated with loss-to-follow-up (Defaulting on ART) of HIV-positive patients and findings revealed that majority of study participants were married (73%) while minority of study participants were not married (23%). Contrary, Mpinganjira, S. et al. [10] on Prevalence and associated factors of treatment failure and Defaulting among HIV AND AIDS Patients showed that out of a total 423 participants, 49.4% were married while 50.6% participants were not married. The observed variation may be as a result of difference in geographical area, study design and sample size. Liao, B. et al. [8] conducted a study on Analysis of factors associated with dropping-out from HIV antiretroviral therapy (Defaulting on ART) on marital status showed 69% participants were mainly single or divorced while 31% participants were married. Mekonnen, N. et al. [6] on incidence and predictors of loss to follow-up (defaulting on ART) among HIV infected adults showed a total of 569 study participants, (54.8%, n = 312) participants were not married while (45.2%, n = 257) participants were married. The observed variation may be as a result of difference in geographical area. Being married may have some positive effects on the prevention of defaulting on ART as they have a supportive partner who can provide emotional and physical support during their antiretroviral therapy. Married individuals also have a greater sense of social support and belonging, which can positively impact their quality of life on ART. However, it is important to note that being single or divorced does not necessarily mean that one has a poor quality of life, as this can be influenced by other factors such as financial stability and access to healthcare facilities.

This study showed that (67%, n = 258) of study participants attained primary education, (23.1%, n = 89) of study participants attained secondary education, (1.3%, n = 5) of study participants attained tertiary education and (8.6%, n = 33) of study participant have never been to school. This finding was in agreement with research done in Malawi by Mpinganjira, S. et al. [10] on factors associated with loss-to-follow-up (Defaulting on ART) of HIV-positive patients and findings revealed that majority of study participants (68%) had primary education while minority of study participants (32%) hand tertiary education or never been to school. A study done by Liao, B. et al. (2019) [8] on Analysis of factors associated with dropping-out from HIV antiretroviral therapy (Defaulting on ART) indicated that nearly 40% of study participants had attained a university level or higher education. This variation where most stopped school at primary level is as a result of poor financial status and education policies to enable a lot of people have access to school. Contrary to the study by Deribe et al., (2017) [11] on defaulters from antiretroviral treatment showed 56% had gone up to secondary and tertiary. This finding suggests that education is a barrier to seeking ART services at a health facility in Zambia. In fact, it is likely that those with low levels of education may be less knowledgeable on ART services and its consequences like high viral load, low CD4 counts, and drug resistance when they continue defaulting on ART.

This study showed that the unemployment rate among the participants was high, with 72.7% being unemployed. This finding is consistent with other similar study conducted in China which also found high unemployment rates among PLWHA defaulting on ART. Liao, B. et al. [8] found that 70.2% of his study participants in China were unemployed while Malama, 2020 found that 53% of their study participants in Malawi were unemployed. The high unemployment levels is related to fast growing population in most of the countries. Contrary to the study by Kaara, F. (2021) [12] on factors Associated with Loss to Follow Up (Defaulting on ART) of HIV Patients Living with HIV showed that 63.3% had employment which was self -employment and formal employment. The variation is as a result of the target group and the sample size in the study conducted in Kenya.

On family support towards ART services to prevent defaulting on ART among patients receiving ART at Chikankata Mission Hospital ART clinic, this study showed that out of 385 participants (51%, n = 198) indicated that they were supported by their relatives and partners towards ART services to prevent defaulting on ART. A study done in Asia by Perera, P. et al. [25] Factors affecting defaulting from services among people living with HIV showed 30.7% lack of partner support was a reason for defaulting on ART while 69.3% supported their partners and relatives on ART to prevent defaulting on ART. Another report done in Ghana by Addis A. [26] on Reasons for defaulting ART 95% participants supported their partners and relatives on ART to prevent PLWHA defaulting ART while 5% participants showed a lack of social support accounting for reasons for PLWHA defaulting on ART. Contrary to the study done in Asia by Ahmed, A. et al. [24] on Barriers and Enablers for Adherence to Antiretroviral Therapy from a total of 25 participants, (48%, n = 12) participants supported their partners on ART to prevent defaulting while 52% never showed support to their partners on ART to prevent defaulting on ART. Discrepancy on family support has been observed in a study in Asia as a result of traditional culture and beliefs on extend extended families in some countries. Culture and traditional beliefs have an influence on pro-social behaviours.

An analysis was carried out to determine whether there were any significant associations between default on ART and socio-demographic characteristics. Age, sex, occupation, education and marital status were all taken into account and none were associated with default on ART. Despite the fact that males were slightly more likely to default than females, this study found no significant association between sex and defaulting on ART which is consistent with the findings from previous studies [5] . Furthermore, previous research has found that age and marital status are not associated with defaulting on ART, which is consistent with the results of the current study [27] . The study found no association between the level of education and defaulting on ART which contradicts the findings of a study conducted in Sri Lanka which found that defaulting on ART services was significantly associated with having a lower educational level [25] . The reason for the different results in this study is unclear. Although the results appeared to indicate that participants in formal employment were more likely to default on ART, this finding was not significant and is in line with findings from earlier studies that found no significant association between occupation and ART defaulting [5] . In terms of factors associated with ART default, the study found that participants who informed the ART clinic when they did not have money for transport were less likely to default on ART than adults who simply stayed at home when they did not have money for transport. Given that nearly half of the participants lived more than 10 kilometres from the ART clinic, and that transportation to health facilities (ART Clinics) was expensive for the majority of participants, it is important to consider the implications of this for defaulting on ART. In this study, transport costs and distance to the health facility were not associated with defaulting on ART which is in line with findings reported in a previous study from Ghana [7] . However, other studies have found that distance to health facilities (ART Clinics) and transport costs are associated with default on ART [13] [25] . It is because of distance to health facilities (ART Clinics) and transport costs that people stay at home and miss their appointments. Instead of waiting until a patient defaults on ART before making contact, health facilities should follow up with patients who miss their ART early to find out why they missed the appointment. Follow-up calls would provide an opportunity for additional counselling sessions. They would also provide a platform for identifying the underlying issues leading to defaulting on ART [20] . The study found that among study participants, defaulting on ART was associated with the perceived importance of always going to ART services. Participants who thought it was somewhat important to always use ART services were more likely to default on ART than participants who thought it was very important to always use ART services. This finding may lead to a better understanding of how important it is to educate patients about the importance of always attending ART services and taking ARVs consistently. Given that almost half of the participants consider it somewhat important to attend ART services, there is a need for more counselling and education to improve their knowledge of this. In previous studies, it was revealed that having sufficient knowledge of HIV and its treatment was associated with a lower risk of defaulting on ART [5] [27] . Therefore, there is need to improve the knowledge of the people on ART to reduce defaulting on ART. Most studies have shown that people who have family support are less likely to default on ART [19] [28] , which is consistent with the findings of this study. Findings from the qualitative study in Pakistan revealed that the lack of support from family members makes it difficult for them to take their medication because they felt less important, anxious or sometimes forgot to take their medication [24] . According to the results of this study, participants who reported poor family support for ART services were more likely to default on ART than those who reported excellent family support for ART services. With almost half of study participants reporting poor family support for ART services, there is a need to develop strategies such as community awareness programmes and sensitisation of close family members to improve family and community support for people living with HIV AND AIDS. However, encouraging family support may be difficult if the person has not disclosed their HIV status to the family. In the case of this study, it is unclear whether the participants’ poor support was simply a result of discrimination and stigma, or because HIV AND AIDS status was not disclosed.

The findings also showed that the length of time participants had to wait to be seen at an ART clinic was significantly associated with defaulting on ART. Participants who reported waiting more than 45 minutes to be seen at the ART clinic were twice as likely to default on ART as those who were seen in less than 45 minutes. A number of studies have consistently found a strong association between ART defaulting and the time spent waiting for treatment [7] . The results of a qualitative study showed that waiting time was viewed as a barrier to ART defaulting because people who lived far away could not afford to be in line for a longer period of time for fear of missing their transportation back home and also due to their work schedules because they could not be off for a longer period of time [13] . More than three quarters of study participants (85.7%) in this study had to wait more than 45 minutes for ART services, which is worrying given that long waiting times are associated with defaulting on ART. Much more work needs to be done in these health facilities (ART Clinics) to reduce waiting times, as they will continue to be a problem and contribute to defaulting on ART. As we strive to reduce ART default among people living with HIV AND AIDS, it is critical to identify the root causes of longer waiting times and address these issues.

More than half of the participants thought that the ART services were good, and the majority indicated that the pharmacists and nurses on duty were rude to them when they picked up ARVs at the ART clinic. However, among the study participants, defaulting on ART was not associated with the perceived quality of the service received. This finding contradicts the results of a Nigerian study, which found that respondents who perceived poor service quality had a 2.6 times greater risk of defaulting on ART [5] .