Antiretroviral therapy in resource-poor settings.Decreasing barriers to access and promoting adherence

Division of Social Medicine and Health Inequalities, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
JAIDS Journal of Acquired Immune Deficiency Syndromes (Impact Factor: 4.39). 01/2007; 43 Suppl 1(Suppl 1):S123-6. DOI: 10.1097/01.qai.0000248348.25630.74
Source: PubMed

ABSTRACT Since 2002, the HIV Equity Initiative of the nongovernmental organization Partners in Health has been expanded in conjunction with the Haitian MOH to cover 7 public clinics. More than 8000 HIV-positive persons, 2300 of whom are on antiretroviral therapy (ART) are now followed. This article describes the interventions to promote access to care and adherence to ART developed in reference to the specific context of poverty in rural Haiti. User fees for clinic attendance have been waived for all patients with HIV and tuberculosis and for women presenting for prenatal services. Additionally, HIV testing has been integrated into the provision of primary care services to increase HIV case finding among those presenting to clinic because of illness, rather than solely focusing on those who present for voluntary counseling and testing (VCT). Once a patient is diagnosed with HIV, medications and monitoring tests are provided free of charge and transportation costs for follow-up appointments are covered to defray patients' out-of-pocket expenses. Patients are given home-based adherence support from a network of health workers who provide psychosocial support and directly observed therapy. In addition, the neediest patients receive nutritional support. Following the description of the program is an approximation of the costs of these interventions and a discussion of their impact.

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Available from: Fernet Léandre, Jul 28, 2015
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    • "Meanwhile it has fallen on NGOs, charity organisations, and faith-based organisations to make available food packages on which many impoverished persons have been able to sustain themselves. Another direct way to promote access to care is to waive user fees, which has been implemented in some countries such as Haiti and South Africa (Mukherjee et al. 2006). "
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    ABSTRACT: Structural barriers to antiretroviral therapy (ART) adherence are economic, institutional, political and cultural factors, that collectively influence the extent to which persons living with HIV follow their medication regimens. We identify three sets of structural barriers to ART adherence that are salient in Southern Africa: poverty-related, institutional, and political and cultural. Examples of poverty-related barriers are competing demands in the context of resource-constrained settings, the lack of transport infrastructure, food insecurity, the role of disability grants and poor social support. Examples of institutional factors are logistical barriers, overburdened health care facilities, limited access to mental health services and difficulties in ensuring adequate counselling. Examples of political and cultural barriers are controversies in the provision of treatment for AIDS, migration, traditional beliefs about HIV and AIDS, poor health literacy and gender inequalities. In forging a way forward, we identify ways in which individuals, communities and health care systems may overcome some of these structural barriers. Finally, we make recommendations for further research on structural barriers to ART adherence. In all likelihood, enhancing adherence to ART requires the efforts of a variety of disciplines, including public health, psychology, anthropology, sociology and medicine.
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    • "Thus it is imperative to question not only how FI contributes to HIV infection, drug access and adherence, related comorbidities and early mortality (e.g. Mukherjee et al. 2006), but also how FI among volunteers impacts their wellbeing and the important labour they provide. However, to date no studies have assessed how FI specifically affects AIDS care volunteers. "
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    • "The relationship of perceived benefit or seriousness of the illness as a motivation for health seeking is supported by similar studies in South Africa and Asia [39] [40] . Providing incentives to clients as a motivator for health seeking should be considered , since it has been found to be useful in other similar settings [41] [42]. Gender inequality influenced dropping out of pre-ARV care and the case of a man denying his four wives access to pre-ARV services gives a contextual image of what may happen in similar family setups. "
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