antiretroviral treatment

A cross-sectional survey was performed in 24 systems of care providing antiretroviral medications in Ethiopia, Kenya, Rwanda, Tanzania, and Uganda to examine current practices in monitoring rates of treatment adherence and defaulting. Only 20 of 48 facilities reported routinely measuring individual patient adherence levels; only 12 measured rates of adherence for the clinic population. The rules for determining which patients were included in the calculation of rates were unclear. Fourteen different definitions of treatment defaulting were in use. Facilities routinely gather potentially useful data, but the frequency of doing so varied widely. Individual and program treatment adherence and defaulting are not routinely monitored; when done, the operational definitions and methods varied widely, making comparisons across programs unreliable. There is a pressing need to determine which measures are the most feasible and reliable to collect, the most useful for clinical counseling, and most informative for program management.

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. 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.

In recent years, global health initiatives have greatly increased the number of patients in low-income countries started on antiretroviral therapy (ART). This creates an urgent need to know how well HIV/AIDS programs maintain patients on therapy. Consensus, however, is lacking on practical, reliable, and valid indicators to monitor program performance on adherence. Recently, the Global Fund became the first funding organization to recommend an adherence indicator to monitor program performance. This is a welcome beginning. International organizations and national AIDS control programs have a clear and urgent need to finalize agreement about standard indicators to monitor patient adherence and retention and to begin to make such data publicly available. UNAIDS and the WHO Department of HIV/AIDS should take the lead in coordinating donor and country collaboration in this important endeavor.

The Government of Cameroon and its partners have made major investments in the last decade in prevention, treatment, and care of HIV-infected patients. However, unmet need for antiretroviral therapy (ART) among HIV-positive pregnant women remains high at 66%. Critical to satisfying this need is ensuring adequate availability of prevention of mother-to-child transmission (PMTCT) commodities for rollout of new Option B+ guidelines. This study examines options for improving the supply and availability of these commodities. Supply chain operational data was collected in July 2014 from central (CENAME) and 4 regional warehouses (CAPRs); 10 district stores; and 30 service delivery points (SDPs), including ART and PMTCT sites. The study also included seven central private-sector logistics firms. In addition, SC cost data was obtained from CENAME and CAPRs financial statements. Data collected served for analysis of three options to improve effectiveness of delivering PMTCT commodities. Asset utilization within the cost recovery system ranged between 73% and 89% while inventory turnover was at 1.5. Therefore, a reliable supply of medicines to SDPs is ensured. However, for PMTCT and ART commodities, distribution to the SDPs was unreliable (in 2013, 40% of prescriptions remained unfilled). Meanwhile, results of the options analysis indicated that the model of CAPRs delivering PMTCT commodities to SDPs was the most desirable. Although the distance traveled was higher, the need for network storage space was minimal. Moreover, its total cost and human resource requirements were more favorable. As a result of disseminating the findings, the Ministry of Health adopted Option 2.

This systematic review (Jan. 2003-Dec. 2014) synthesized evidence on interventions that have directly reduced mortality in high-HIV-prevalence populations. Antiretroviral therapy (ART)was the only intervention identified that decreased death in HIV-infected pregnant and postpartum women. Multivitamin use was shown to reduce disease progression while other micronutrients and antibiotics had no beneficial effect on maternal mortality. The findings support global trends in encouraging initiation of lifelong ART for all HIV-infected pregnant and breastfeeding women (Option B+), regardless of their CD4+ count, as an important step in ensuring appropriate care and 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.

In July 2011, Malawi introduced an ambitious public health program known as “Option B+,” which provides all HIV- infected pregnant and breastfeeding women with lifelong combination antiretroviral therapy, regardless of clinical stage or CD4 count. Option B+ is expected to have benefits for HIV-infected women, their HIV-exposed infants, and their HIV-uninfected male sex partners. However, these benefits hinge on early uptake of prevention of mother-to-child transmission, good adherence, and long-term retention in care. The Prevention of mother-to-child transmission Uptake and REtention (PURE) study is a 3-arm cluster randomized controlled trial to evaluate whether clinic- or community-based peer support will improve care-seeking and retention in care by HIV- infected pregnant and breastfeeding women, their HIV-exposed infants, and their male sex partners, and ultimately improve health outcomes in all 3 populations. We describe the PURE Malawi Consortium, the initial work conducted to inform the trial and interventions, the trial design, and the analysis plan. We then discuss concerns and expected contributions to Malawi and the region.

Approximately 1 million people are infected with HIV in Malawi, where AIDS is the leading cause of death in adults. By December 31, 2007, more than 141,000 patients were initiated on antiretroviral treatment (ART) by use of a public health approach to scale up HIV services. In Malawi, a public health approach to ART increased treatment access and maintained high 6- and 12-month survival. Resource-limited countries scaling up ART programs may benefit from this approach of simplified clinical decision making, standardized ART regimens, nonphysician care, limited laboratory support, and centralized monitoring and evaluation.

As national antiretroviral treatment (ART) programmes scale up, it is essential that information is complete, timely and accurate for site monitoring and national planning. This study assessed the quality of quarterly aggregate summary data for April to June 2006 compiled and reported by ART facilities as compared to the "gold standard" facility summary data compiled independently by the Ministry of Health supervision team. The national summary using the site reports resulted in a 12% undercount in the national total number of persons on first-line treatment. While many sites are able to generate complete data summaries, the accuracy of facility reports is not yet adequate for national monitoring. The Ministry of Health and its partners should continue to identify and support interventions such as supportive supervision to build sites' capacity to maintain and compile quality data to ensure that accurate information is available for site monitoring and national planning.

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