Life Line: Increasing Adherence to Treatment with a Telephone
In Ethiopia, 85 percent of the country’s 73.9 million people live in isolated rural areas, bringing significant challenges to HIV & AIDS testing and treatment programs. Yet despite these obstacles, the country has made significant strides. Within two years, the number of clients on active antiretroviral treatment tripled from 50,000 to 167,271.
Tesfa Taye is a pharmacist and the representative of the pharmacy case team at Selam Health Center in Ethiopia. He stressed the urgent need to remind patients to adhere to their medicines, but was unable to follow up with patients directly because the health center did not have an available phone line. The success of antiretroviral therapy (ART) depends on patients’ adherence – lack of adherence can result in treatment failure and contribute to drug resistance. If patients default on their treatment by not consistently taking the required medication, the virus itself will become unaffected by the available medicine, resulting in the patient becoming sicker or, dying.
Management Science for Health’s (MSH) Strengthening Pharmaceutical Services (SPS) program funded by the U.S. Agency for International Development (USAID) arranged for the installation of a new telephone line at Selam Health Center in 2009. Since then, more than 300 patients that had not come in for their follow-up treatments have been tracked down and 240 have reinitiated treatment – more than 78%. Moreover, it was discovered that 45 had died, 9 moved out of the area, and 13 could not be traced.
“Before we got this new telephone line, we only had one line for the medical director’s use. We were only allowed to make calls for urgent purposes. But now thanks to USAID’s support and funding of SPS we are able to communicate with patients, the sub‐city, the health bureau and the Pharmaceutical Funding and Supply Agency. We are especially grateful for this support for it allows us to contact our patients who do not follow up with treatment,” said Taye.
“We call patients one day before their appointments. We also call if they fail to come in on the day of their appointment. Before the installment of the telephone line, communication was very poor and our service was of poor quality,” Taye continued.
The telephone line also is used to assure patients that the same service is available at other health centers if they need to travel. If patients cannot return to the Selam Health Center, the pharmacist is able to call other health facilities to provide patient histories.
Yeshiwork Mulugeta, an HIV positive woman, began ART at Selam Health Center when she was very sick, but once she started feeling better she stopped taking the medicines to avoid the stigma associated with HIV. A few months later, Taye called her to tell her about the dangers of not adhering to ART. He encouraged Yeshiwork to return to the health center and continue taking her medicines regularly. “If the pharmacist did not call and advise me to adhere, who knows, I might be dead or even crippled for life. I am always grateful that he cared to call,” says Yeshiwork.
According to Taye, having a telephone line solves several problems not only for ART services but also for the entire health center, “thanks to this privilege, our work has become easier and more fruitful.”
The SPS Program, funded by USAID, provides a broad range of technical assistance and resources to help Ethiopia ensure an uninterrupted supply of antiretroviral medicines and build the country’s capacity in human resources, pharmaceutical systems, and infrastructure to provide ART.