Voices on adherence to ART in Ethiopia and Uganda

A matter of choice or simply not an option

Bibliographic Data

ID19443857
AuthorsAnnelie K Gusdal (0000-0002-6448-5866, Karolinska Institutet, corresponding author), Celestino Obua (0000-0001-6949-3059, b Department of Pharmacology and Therapeutics , Makerere University Medical School , Kampala , Uganda), Tenaw Andualem (c Strengthening Pharmaceutical Systems , Management Sciences for Health , Addis Ababa , Ethiopia), Rolf Wahlström (Karolinska Institutet), G Tomson (0000-0001-9222-3604, Karolinska Institutet), Stefan Peterson (0000-0001-7203-3096, Karolinska Institutet), Anna Mia Ekström (0000-0002-3912-1171, Karolinska Institutet), Anna Thorson (0000-0002-8703-6561, Karolinska Institutet), John Chalker (0000-0002-3282-9900, Management Sciences for Health), Grethe Fochsen (Karolinska Institutet), on behalf of the INRUD-IAA project on behalf of the INRUD-IAA project (h The International Network for the Rational Use of Drugs Initiative on Adherence to Antiretroviral Therapy), on behalf of the INRUD-IAA project
Year2009
Volume21
Issue11
Pages1381-1387
Publication date2009-11-01
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueAIDS Care (JOURNAL)
Journal identifiersISSN: 0954-0121 • E-ISSN: 1360-0451
PublisherInforma UK Limited (PUBLISHER • GB)
DOI10.1080/09540120902883119
PMID20024714
OpenAlexW2023677083
LanguageEN
Citations received13
References cited19

This paper explores HIV patients' adherence to antiretroviral treatment (ART) in resource-limited contexts in Uganda and Ethiopia, where ART is provided free of charge. Qualitative semi-structured interviews were conducted with 79 patients, 17 peer counselors, and 22 providers in ART facilities in urban and rural areas of Ethiopia and Uganda. Interviewees voiced their experiences of, and views on ART adherence both from an individual and a system level perspective. Two main themes emerged from the content analysis: "Patients' competing costs and systems' resource constraints" and "Patients' trust in ART and quality of the patient-provider encounters." The first theme refers to how patients' adherence was challenged by difficulties in supporting themselves and their families, paying for transportation, for drug refill and follow-up as well as paying for registration fees, opportunistic infection treatment, and expensive referrals to other hospitals. The second theme describes factors that influenced patients' capacity to adhere: personal responsibility in treatment, trust in the effects of antiretroviral drugs, and trust in the quality of counseling. To grant patients a fair choice to successfully adhere to ART, transport costs to ART facilities need to be reduced. This implies providing patients with drugs for longer periods of time and arranging for better laboratory services, thus not necessitating frequent revisits. Services ought to be brought closer to patients and peripheral, community-based healthworkers used for drug distribution. There is a need for training providers and peer counselors, in communication skills and adherence counseling

Geography · Sociology · HIV/AIDS Research and Interventions · LGBTQ Health, Identity, and Policy · Psychology · Sex work and related issues