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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
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, Volume 19, No. 5, Year 2007
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Description
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. © 2007 Taylor & Francis.
Authors & Co-Authors
Hardon, Anita Petra
Netherlands, Amsterdam
Universiteit Van Amsterdam
Akurut, D.
Netherlands, Amsterdam
Universiteit Van Amsterdam
Comoro, Christopher
Tanzania, Dar es Salaam
University of Dar es Salaam
Ekezie, C.
Botswana
Sekgoma Memorial Hospital
Irunde, Henry
Tanzania, Dar es Salaam
Tanzania Food and Drugs Authority
Gerrits, T.
Netherlands, Amsterdam
Universiteit Van Amsterdam
Kglatwane, J.
Botswana, Gaborone
Botswana Essential Drugs Action Program
Kinsman, John
Netherlands, Amsterdam
Universiteit Van Amsterdam
Kwasa, R.
Uganda, Jinja
Jinja Regional Referral Hospital
Maridadi, J.
Tanzania
National Institute for Medical Research Tanzania
Modie-Moroka, Tirelo
Botswana, Gaborone
University of Botswana
Moyo, Sikhulile M.
Botswana, Gaborone
Botswana Harvard Aids Institute Partnership
Nakiyemba, Alice
Uganda, Iganga
Busoga University
Nsimba, Stephen Elias Damson
Tanzania, Dar es Salaam
Muhimbili University of Health and Allied Sciences
Ogenyi, R.
Botswana
Mahalapye District Hospital
Oyabba, T.
Uganda, Iganga
Busoga University
Temu, Florence
Tanzania, Mwanza
African Medical and Research Foundation Mwanza
Laing, Richard Ogilvie
Switzerland, Geneva
Organisation Mondiale de la Santé
Statistics
Citations: 524
Authors: 18
Affiliations: 14
Identifiers
Doi:
10.1080/09540120701244943
ISSN:
09540121
e-ISSN:
13600451
Research Areas
Food Security
Infectious Diseases
Study Design
Cohort Study
Study Approach
Qualitative
Study Locations
Botswana
Tanzania
Uganda