adherence to treatment

This qualitative study at six health facilities in Kenya assessed how staff perceived and used an appointment-keeping system and a revised clinic form to monitor patients’ adherence to antiretroviral treatment. Early detection of treatment defaulters helped the providers to design targeted patient support to enhance appointment keeping. The intervention led to implementation of changes in clinics to enhance patients’ appointment keeping and improve adherence to treatment.

The intention of this study was to determine prevalence and associated factors with adherence to highly active ART among people living with HIV/AIDS (PLWHA) at the Debrebrihan Referral Hospital and Health Center, Northeast Ethiopia. A cross-sectional study design with systematic random sampling was conducted using a structured adherence questionnaire among 422 respondents from the hospital. Adherence was defined as not missing a single ART dose during the 30-day period prior to filling out the self-report. Among the participants, 95.5% were taking their medication without missing a dose. Factors such as having emotional or practical support positively encouraged ART adherence. However, users of traditional, complementary, and alternative medicine (TCAM) had a nearly five times higher risk for ART nonadherence (p = 0.05) than those not using TCAM. Strengthening emotional and practical support for PLWHA and integrating TCAM with the proper use of ART are vital to enhance ART adherence.

We assessed adherence to standards of HIV care among health workers in the West Nile Region of Uganda. We conducted a cross-sectional study in nine health facilities and assessed records of a cohort of 270 HIV clients that enrolled on ART 12 months prior. The performance of each health facility on the different indicators of standards of HIV/AIDS care was determined and compared with the recommended national guidelines. Adherence to standards of HIV/AIDS care at facilities was inadequate. Performance was better at the start of ART but declined during the follow-up period. Higher level facilities were more likely to adhere to standards like CD4 monitoring and maintaining HIV clients on a standard ARV regimen. Efforts geared towards strengthening the health system, including support supervision and provision of care guidelines and job aides are needed, especially for lower level facilities.

This study assessed the effects of facility-based interventions using existing resources to improve overall patient attendance and adherence to antiretroviral therapy (ART) at ART-providing facilities in Uganda. Patients’ adherence was improved with low-cost and easily implemented interventions using existing health facilities’ resources. We recommend that such interventions be considered for scale-up at national levels as measures to improve clinic attendance and ART adherence among patients in Uganda and other low-resource settings in sub-Saharan Africa.

Achieving high rates of adherence to antiretroviral therapy (ART) in resource-poor settings comprises serious, but different, challenges in both the first months of treatment and during the life-long maintenance phase. We measured the impact of a health system-oriented, facility-based intervention to improve clinic attendance and patient adherence. We conducted the study in 12 rural district hospitals (6 intervention, 6 control) in Kenya and randomly selected 1,894 adult patients over 18 years of age in two cohorts. Among experienced patients, the percentage attending the clinic on or before a scheduled appointment increased in both level and trend (increase per month) following the intervention, as did the level and trend of those keeping appointments within three days.

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