(ARV-) Free State? The moratorium's threat to patients’ adherence and the development of drug-resistant HIV

South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde (Impact Factor: 1.63). 07/2009; 99(6):412, 414.
Source: PubMed
Download full-text


Available from: Marlise Linda Richter
  • Source
    • "Treatment free of charge facilitates patient uptake of HAART, but failures in the supply line for antiretrovirals may also interrupt adherence[30]. In June 2011, Ghana had to draw down emergency supplies of ARVs priced at USD1.5 million[31], and in July 2011 protests occurred in Algeria[32] and Swaziland[33] over ARV supply problems. "
    [Show abstract] [Hide abstract]
    ABSTRACT: ABSTRACT: This paper reviews the healthcare issues facing nations which have a substantial caseload of chronic HIV cases. It considers the challenges of extending antiretroviral coverage to an expanding caseload as supplier price rises and international trade agreements come into force to reduce the availability of affordable antiretrovirals just as the economic downturn restricts donor funding. It goes on to review the importance in this context of supporting adherence to drug regimens in order to preserve access to affordable antiretrovirals for those already on treatment, and of removing key barriers such as patient fees and supply interruptions. The demands of those with chronic HIV for health services other than antiretroviral therapy are considered in the light of the fearful or discriminatory attitudes of non-specialist healthcare staff due to HIV-related stigma, which is linked with the weakness of infection control measures in many health facilities. The implications for prevention strategies including those involving criminalisation of HIV transmission or exposure are briefly summarised for the current context, in which the caseload of those whose chronic HIV infection must be controlled with antiretrovirals will continue to rise for the foreseeable future.
    Full-text · Article · Oct 2011 · Globalization and Health
  • Source
    • "In addition to traditional understanding of effective treatment, the sharing of ARVs was cited by community participants as a barrier to adherence. This phenomenon has been documented elsewhere [51-53]. Patients may have resorted to sharing medication during "stock-outs" that have occurred, especially early in ART roll-out. "
    [Show abstract] [Hide abstract]
    ABSTRACT: HIV is treated as a chronic disease, but high lost-to-follow-up rates and poor adherence to medication result in higher mortality, morbidity, and viral mutation. Within 18 clinical sites in rural Zambézia Province, Mozambique, patient adherence to antiretroviral therapy has been sub-optimal. To better understand barriers to adherence, we conducted 18 community and clinic focus groups in six rural districts. We interviewed 76 women and 88 men, of whom 124 were community participants (CP; 60 women, 64 men) and 40 were health care workers (HCW; 16 women, 24 men) who provide care for those living with HIV. While there was some consensus, both CP and HCW provided complementary insights. CP focus groups noted a lack of confidentiality and poor treatment by hospital staff (42% CP vs. 0% HCW), doubt as to the benefits of antiretroviral therapy (75% CP vs. 0% HCW), and sharing medications with family members (66% CP vs. 0%HCW). Men expressed a greater concern about poor treatment by HCW than women (83% men vs. 0% women). Health care workers blamed patient preference for traditional medicine (42% CP vs. 100% HCW) and the side effects of medication for poor adherence (8% CP vs. 83% CHW). Perspectives of CP and HCW likely reflect differing sociocultural and educational backgrounds. Health care workers must understand community perspectives on causes of suboptimal adherence as a first step toward effective intervention.
    Full-text · Article · Aug 2011 · BMC Public Health
  • Source
    • "Acute programme disruptions were uncommon and rarer than expected; the only programme to face such disruption was Bukavu, DRC, for 2 weeks in 2005[11]. Disruptions can occur even in 'stable' settings, either due to unexpected conflict such as in Kenya in 2008[31] or through drug ruptures secondary to mismanagement or financial limitations [32]. Thus many of the practical measures used in these settings could be applied in all HIV programmes and also to particular populations at higher risk of interruption such as migrants and nomadic populations. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Many countries ravaged by conflict have substantial morbidity and mortality attributed to HIV/AIDS yet HIV treatment is uncommonly available. Universal access to HIV care cannot be achieved unless the needs of populations in conflict-affected areas are addressed. From 2003 Médecins Sans Frontières introduced HIV care, including antiretroviral therapy, into 24 programmes in conflict or post-conflict settings, mainly in sub-Saharan Africa. HIV care and treatment activities were usually integrated within other medical activities. Project data collected in the Fuchia software system were analysed and outcomes compared with ART-LINC data. Programme reports and other relevant documents and interviews with local and headquarters staff were used to develop lessons learned. In the 22 programmes where ART was initiated, more than 10,500 people were diagnosed with HIV and received medical care, and 4555 commenced antiretroviral therapy, including 348 children. Complete data were available for adults in 20 programmes (n = 4145). At analysis, 2645 (64%) remained on ART, 422 (10%) had died, 466 (11%) lost to follow-up, 417 (10%) transferred to another programme, and 195 (5%) had an unclear outcome. Median 12-month mortality and loss to follow-up were 9% and 11% respectively, and median 6-month CD4 gain was 129 cells/mm 3.Patient outcomes on treatment were comparable to those in stable resource-limited settings, and individuals and communities obtained significant benefits from access to HIV treatment. Programme disruption through instability was uncommon with only one program experiencing interruption to services, and programs were adapted to allow for disruption and population movements. Integration of HIV activities strengthened other health activities contributing to health benefits for all victims of conflict and increasing the potential sustainability for implemented activities. With commitment, simplified treatment and monitoring, and adaptations for potential instability, HIV treatment can be feasibly and effectively provided in conflict or post-conflict settings.
    Full-text · Article · Jun 2010 · Conflict and Health
Show more