Objectives
The objective of this study is to identify barriers and facilitators of anti-retroviral treatment (ART) continuation among ART patients in Zambia. It also aims to explore ART scale-up approach while reducing defaulters.
Methods
In October 2009, we obtained ART statistics, interviewed District Health Management Team (DHMT) in Livingstone, Zambia, and conducted Focus Group Discussion (FGD) with 27 ART defaulters who were traceable, where participants shared experience in relation to why they gave up and how they resumed treatment.
Results
Although ART facilities have been increased in Livingstone, half of the facilities are not equipped with CD4 count machine, which affects timely commencement of treatment. Anti-retrovirals (ARV) and consultation are basically offered free of charge to ART patients, yet patients have to pay X-ray and co-morbidity treatment. On average, 22.7% of ART patients stopped visiting ART facilities. Especially in large-scale ART centre, defaulters were not followed up. FGD revealed the process of how defaulters developed hopelessness and pill burden, which were triggered and influenced by several factors including hunger, poverty, stigma, side-effects and co-morbidities. Some stopped medication as they thought being cured after condition recovered. Others attributed discontinuation to the accessibility of service and the attitude of ART centre staff. Default was attributed by internal (inadequate knowledge, weak motivation) and also external (hunger, medical service system) factors. It is inevitable to empower patients with adherence management by strong motivation to treatment and supportive environment.
Conclusion
Financial empowerment of patients, free-service of co-morbidity treatment and side effect mitigation are desirable for sustainable ART scale-up. Defaulter follow-up, continuous regular adherence counseling and ART roll-out to small-scale clinics are inevitable to reduce defaulters.

To determine the physical symptoms and ki, ketsu and sui (qi, blood and fluid) factors associated with the presence of hie-sho (chill syndrome). Total 118 healthy university students (66 males and 52 females, median age 22 years, range 21­-29) were enrolled. A cross-­sectional study about the presence of chill syndrome in par­ticipants was performed. Terasawa's ki, ketsu and sui diagnostic score was used to identify the presence of physical symptoms. Number rating scale (NRS) was used to classify the chill and NRS more than 5 was de­fined as chill syndrome based on Furuya's report. Eighteen students (4 males and 14 females) were docu­mented as chill syndrome. The multivariate analysis of physical symptoms identified female (OR 4.65, p = 0.0427), heavy sensation of head (OR 2.98, p = 0.0190) and chill of extremities (OR 1.94, p = 0.0480) as sig­nificantly associated factors with chill syndrome. The score of ki-kyo (qi deficiency), ketsu-kyo (blood defi­ciency) and suitai (fluid retention) showed higher score in students with chill syndrome compared to students without chill syndrome in univariate analysis. Being female and two indicators of qi abnormalities including heavy sensation of head and chill of extremities were associated with the presence of chill syndrome in univer­sity students.