Article,
Hunger, waiting time and transport costs: Time to confront challenges to ART adherence in Africa
AIDS Care, 19 (5): 658-665 (May 2007)M3: Article; Accession Number: 25084486; Hardon, A. P. 1 Akurut, D. 2 Comoro, C. 3 Ekezie, C. 4 Irunde, H. F. 5 Gerrits, T. 1 Kglatwane, J. 6 Kinsman, J. 1 Kwasa, R. 7 Maridadi, J. 8 Moroka, T. M. 9 Moyo, S. 10 Nakiyemba, A. 11 Nsimba, S. 12 Ogenyi, R. 13 Oyabba, T. 11 Temu, F. 14 Laing, R. 15; Affiliation: 1: University of Amsterdam, Amsterdam School for Social Science Research, Amsterdam, Netherlands 2: University of Amsterdam, Amsterdam School for Social Science Research, Kampala, Uganda 3: University of Dar es Salaam, Dar es Salaam, United Republic of Tanzania 4: Sekgoma Memorial Hospital, Sekgoma, Botswana 5: Tanzania Food and Drug Authority, Dar es Salaam, United Republic of Tanzania 6: Botswana Essential Drugs Action Program, Gaborone, Botswana 7: Jinja Regional Referral Hospital, Jinja, Uganda 8: National Institute of Medical Research, Dar es Salaam, United Republic Of Tanzania 9: University of Botswana, Social Work Department, Gabarone, Botswana 10: Botswana-Harvard School of Public Health, Aids Initiative Partnership, Gabarone, Botswana 11: Busoga University, Jinja, Uganda 12: Muhimbili University, College of Health Sciences, Dar es Salaam, United Republic of Tanzania 13: Mahalapye District Hospital, Mahalapye, Botswana 14: AMREF, Dar es Salaam, United Republic of Tanzania 15: World Health Organization, Department of Medicines policy and standards, Geneva, Switzerland; Source Info: May2007, Vol. 19 Issue 5, p658; Subject Term: ANTIRETROVIRAL agents; Subject Term: DRUG resistance; Subject Term: MEDICAL care; Subject Term: MEDICINE -- Research; Subject Term: AFRICA; NAICS/Industry Codes: 541712 Reseach and Development in the Physical, Engineering, and Life Sciences (except Biotechnology); Number of Pages: 8p; Illustrations: 4 charts, 1 graph; Document Type: Article.
Abstract
Adherence levels in Africa have been found to be better than those in the US. However around one out of four ART users fail to achieve optimal adherence, risking drug resistance and negative treatment outcomes. A high demand for 2nd line treatments (currently ten times more expensive than 1st line ART) undermines the sustainability of African ART programs. There is an urgent need to identify context-specific constraints to adherence and implement interventions to address them. We used rapid appraisals (involving mainly qualitative methods) to find out why and when people do not adhere to ART in Uganda, Tanzania and Botswana. Multidisciplinary teams of researchers and local health professionals conducted the studies, involving a total of 54 semi-structured interviews with health workers, 73 semi-structured interviews with ARTusers and other key informants, 34 focus group discussions, and 218 exit interviews with ART users. All the facilities studied in Botswana, Tanzania and Uganda provide ARVs free of charge, but ART users report other related costs (e.g. transport expenditures, registration and user fees at the private health facilities, and lost wages due to long waiting times) as main obstacles to optimal adherence. Side effects and hunger in the initial treatment phase are an added concern. We further found that ART users find it hard to take their drugs when they are among people to whom they have not disclosed their HIV status, such as co-workers and friends. The research teams recommend that (i) health care workers inform patients better about adverse effects; (ii) ART programmes provide transport and food support to patients who are too poor to pay; (iii) recurrent costs to users be reduced by providing three-months, rather than the one-month refills once optimal adherence levels have been achieved; and (iv) pharmacists play an important role in this follow-up care. ABSTRACT FROM AUTHOR; Copyright of AIDS Care is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts)
