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[e-drug] ARV adherence study in Africa highlights key challenges

E-DRUG: ARV adherence study in Africa highlights key challenges
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[Important lessons on adherence and the challenges of ART in Africa. Copied
as fair use; WB]
 
ARV adherence study in Africa highlights key challenges
 
Hunger, waiting time and transport costs: Time to confront challenges to ART 
adherence in Africa
 
A. P. Hardon1, D. Akurut2, C. Comoro3, C. Ekezie4, H. F. Irunde5, T.
Gerrits1, J. Kglatwane6, J. Kinsman1, R. Kwasa7, J. Maridadi8, T. M.
Moroka9, S. Moyo10, A. Nakiyemba11, S. Nsimba12, R. Ogenyi13, T. Oyabba14,
F. Temu15, & R. Laing16
 
1University of Amsterdam, Amsterdam School for Social Science Research,
Amsterdam, Netherlands, 2University of Amsterdam, Amsterdam School for
Social Science Research, Kampala, Uganda, 3University of Dar es Salaam, Dar
es Salaam, United Republic of Tanzania, 4Sekgoma Memorial Hospital, Sekgoma, 
Botswana, 5Tanzania Food and Drug Authority, Dar es Salaam, United Republic of 
Tanzania, 6Botswana Essential Drugs Action Program, Gaborone, Botswana, 7Jinja 
Regional Referral Hospital, Jinja, Uganda, 8National Institute of Medical 
Research, Dar es Salaam, United Republic Of Tanzania, 9University of Botswana, 
Social Work Department, Gabarone, Botswana, 10Botswana-Harvard School of Public 
Health, Aids Initiative Partnership, Gabarone, Botswana, 11Busoga University, 
Jinja, Uganda, 12Muhimbili University, College of Health Sciences, Dar es 
Salaam, United Republic of Tanzania, 13Mahalapye District Hospital, Mahalapye, 
Botswana, 14Busoga University, Jinja, Uganda, 15AMREF, Dar es Salaam, United 
Republic of Tanzania, and 16World Health Organization, Department of Medicines 
policy and standards, Geneva, Switzerland
 
AIDS Care, May 2007; 19(5): 658-665

This study used rapid appraisals (involving mainly qualitative methods) to
investigate why and when people do not adhere to ART in Uganda, Tanzania and 
Botswana. Multidisciplinary teams of researchers and local health
professionals conducted the work, involving a total of 54 semi-structured
interviews with health workers, 73 semi-structured interviews with ART users 
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 reported 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 critical obstacles to achieving 
optimal adherence levels. 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.
 

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