Hunger, waiting time and transport costs: time to confront challenges to ART adherence in Africa.

Anita Petra Hardon (1) , Henry Fillemon Irunde (2) , Joyce Kglatwane (3) , John Kinsman (1) , Alice Nakiyemba (4) , Dorothy Chantal Akurut (5) , Christopher Comoro (6) , Cosmas Ekezie (7) , Richard Kwasa (8) , Janneth Maridadi (9) , Tirelo Modie-Moroka (10) , Sikhulile Moyo (11) , Stephen E.D. Nsimba (12) , Robert Ogenyi (13) , Thomas Oyabba (14) , Florence Temu (15) , Trudie Gerrits (5) , Richard Laing (16)

1 Amsterdam School for Social Science Research
2 Tanzania Food and Drug Authority
3 Botswana Essential Drugs Action Program
4 Busoga Unversity
5 Amsterdam School for Social Science Research
6 UDSM - Université de Dar es Salaam
7 Sekgoma Memorial Hospital
8 Jinja Regional Referral Hospital
9 National Institute of Medical Research
10 Social Work Department
11 Botswana-Harvard School of Public Health, Aids Initiative Partnership
12 College of Health Sciences
13 Mahalapye District Hospital
14 Busoga University
15 AMREF
16 Department of Medicines policy and standards

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 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 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.

Mots clés: Life Sciences

Anita Petra Hardon, Henry Fillemon Irunde, Joyce Kglatwane, John Kinsman, Alice Nakiyemba, et al.. Hunger, waiting time and transport costs: time to confront challenges to ART adherence in Africa.. AIDS Care, 2007, 19 (05), pp.658-665. ⟨10.1080/09540120701244943⟩. ⟨hal-00513422⟩