Hunger, waiting time and transport costs: Time to confront challenges to ART adherence in Africa
Hunger, waiting time and transport costs: Time to confront challenges to ART adherence in Africa
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DOI：
10.1080/09540120701244943
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发表时间：
2007-01-01
影响因子：
1.7
通讯作者：
Laing, R.
中科院分区：
文献类型：
--
作者：
Hardon, A. P.;Akurut, D.;Laing, R.
非洲的遵守水平被发现比美国好。然而，大约四分之一的抗逆转录病毒药物使用者未能实现最佳依从性，存在耐药性和负面治疗结果的风险。对二线治疗的高需求（目前比一线ART贵十倍）破坏了非洲ART项目的可持续性。迫切需要查明具体情况对遵守的制约因素，并采取干预措施加以解决。我们使用快速评估（主要涉及定性方法）来找出乌干达，坦桑尼亚和博茨瓦纳人们不坚持ART的原因和时间。由研究人员和当地卫生专业人员组成的多学科团队进行了这些研究，共涉及54次与卫生工作者的半结构化访谈，73次与ART使用者和其他关键信息提供者的半结构化访谈，34次焦点小组讨论，以及218次与ART使用者的离职访谈。在博茨瓦纳、坦桑尼亚和乌干达研究的所有设施都免费提供抗逆转录病毒药物，但抗逆转录病毒药物使用者报告了其他相关费用（例如：G.交通费用、私人保健设施的登记费和使用费，以及由于等待时间长而造成的工资损失）是最佳坚持的主要障碍。在初始治疗阶段的副作用和饥饿是一个额外的问题。我们进一步发现，ART使用者发现当他们与他们没有透露艾滋病毒状况的人在一起时很难服用药物，例如同事和朋友。研究小组建议：（i）卫生保健工作者更好地告知患者不良反应;（ii）抗逆转录病毒疗法方案为太穷而付不起费用的患者提供交通和食物支持;（iii）一旦达到最佳坚持水平，通过提供三个月的补充而不是一个月的补充来减少使用者的经常性费用;（iv）药剂师在这种后续护理中发挥重要作用。
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.