Hunger, waiting time and transport costs: Time to confront challenges to ART adherence in Africa
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Date
2007
Journal Title
Journal ISSN
Volume Title
Publisher
Psychological and Socio-medical Aspects of AIDS/HIV
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.
Description
Keywords
Hunger, Time, Transport costs, ART adherence
Citation
A. P. Hardon , D. Akurut , C. Comoro , C. Ekezie , H. F. Irunde , T. Gerrits , J. Kglatwane , J. Kinsman , R. Kwasa , J. Maridadi , T. M. Moroka , S. Moyo , A. Nakiyemba , S. Nsimba , R. Ogenyi , T. Oyabba , F. Temu & R. Laing (2007) Hunger, waiting time and transport costs: Time to confront challenges to ART adherence in Africa, AIDS Care: Psychological and Socio-medical Aspects of AIDS/HIV, 19:5, 658-665, DOI: 10.1080/09540120701244943