From access to adherence: the challenges of antiretroviral treatment
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Date
2006
Journal Title
Journal ISSN
Volume Title
Publisher
World Health Organization
Abstract
Since the launch of WHO’s ʹ3 by 5ʹ initiative in 2003, many countries in sub‐Saharan
Africa have established national antiretroviral treatment (ART) programmes. Although
the WHO target of providing access to ART for 3 million people by 2005 was not
achieved, by end‐2005 an estimated 1.3 million people in low‐ and middle‐income
countries had access to treatment (about 20% of those estimated to be in need) (WHO
and UNAIDS, 2006). By mid‐2005, the WHO target had already been overtaken by an
even more ambitious aim. In July 2005, the G8 group of industrialized countries
committed to the goal of achieving ʹas close as possible to universal access to treatment
for all those who need it by 2010.ʹ (UNAIDS, 2006, G8 Gleneagles Summit, 2005).
Nonetheless, the challenges in the region remain great. Health systems are weak, and
the target orientation of ART programmes risks an emphasis on initiating people on
ART at the expense of ensuring effective use of medicines. As discussed in Chapter 2,
extremely high levels of adherence (at least 95%) are needed to ensure positive
treatment outcomes and prevent the development of drug‐resistance (Paterson et al.,
2000).
Up till now, only limited operational research has been carried out to identify
adherence problems in resource‐poor settings and to strengthen adherence support
(Jaffar et al., 2005; Bennet, Boerma and Brugha, 2006; Kent et al., 2003; Akileswaran et
al., 2005; Farmer et al., 2001). Previous studies on adherence to ART in Africa have
provided quantitative estimates of adherence and data on clinical outcomes, mainly
from experimental settings (Ivers, Kendrick and Doucette, 2005; Coetzee et al., 2004;
Orrell et al., 2003; Koenig, Léandre and Farmer, 2004; Gill et al., 2005). A recent review
of six of these studies reported that 68%‐99% of patients took at least 95% of their
medicines. The authors, Ivers et al., conclude that adherence levels in Africa are high,
i.e. comparable to those in industrialized settings. However, Gill and colleagues (2005)
and Laurent et al., 2002) stress that there is no room for complacency, noting that
adherence rates tend to deteriorate over time.
Description
Keywords
Access, Adherence, Antiretroviral treatment
Citation
Hardon, A., Davey, S., Gerrits, T., Hodgkin, C., Irunde, H., Kgatlwane, J., ... & World Health Organization. (2006). From access to adherence: the challenges of antiretroviral treatment: studies from Botswana, Tanzania and Uganda 2006. World Health Organization.