Article

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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    • "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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