Obstacles and Proposed Solutions to Effective Antiretroviral Therapy in Resource-Limited Settings

Bartlett, John A.; Hornberger, John; Shewade, Ashwini; Bhor, Menaka; Rajagopalan, Rukmini

doi:10.1177/1545109709337745

Cited by 14 publications

(15 citation statements)

References 28 publications

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“…The nearly half day waiting time caused them to forego income from not working, particularly among those patients who had fixed-hour jobs and were required to be absent from work to receive treatment. This problem is similar to the findings of the study by Bartlett et al44 which show that some patients had to be absent from work in order to receive treatment due to inappropriate service times. In terms of the date and time of ART service, only 14.7% of all respondents deemed the days and hours to be inappropriate due to the fact that the service for ART was normally available during the same periods of other general health care services, so HIV/AIDS patients more or less were forced to reveal their identities; this result reflects the patients’ fears of social stigma.…”

Section: Discussionsupporting

confidence: 87%

Access to antiretroviral therapy among HIV/AIDS patients in Chiang Mai province, Thailand

Himakalasa¹,

Grisurapong²,

Phuangsaichai³

2013

HIV

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The objective of this study is to investigate the access to antiretroviral treatment among human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) patients in Chiang Mai province, Thailand. Access to antiretroviral treatment is defined in terms of availability, affordability, and acceptability. The data for the study were collected during the period of April 1, 2012–May 31, 2012 from a sample of 380 HIV/AIDS patients in eight hospitals who had received antiretroviral treatment for more than 6 months at the time of data collection. The results of the study show that for most patients, the average traveling time to access health care was acceptable, but the nearly half day waiting time caused them to be absent from their work. In particular, it took longer for patients in the rural and lower income groups to access the treatment than the other groups. Their travel times and food costs relating to the treatment were found to be relatively high and therefore these patients had a higher tendency to borrow or seek financial assistance from their relatives. However, due to improvements in the access to treatment, most patients were satisfied with the services they received. The results imply that policy should be implemented to raise the potential of subdistrict hospitals where access to antiretroviral treatment is available, with participating HIV/AIDS patients acting as volunteers in providing services and other forms of health promotion to new patients. Privacy issues could be reduced if the antiretroviral treatment was isolated from other health services. Additionally, efforts to educate HIV/AIDS patients and society at large should be made.

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Section: Discussionsupporting

confidence: 87%

Access to antiretroviral therapy among HIV/AIDS patients in Chiang Mai province, Thailand

Himakalasa¹,

Grisurapong²,

Phuangsaichai³

2013

HIV

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“…HIV positive individuals who did not disclose their HIV status to their spouses/partners were more likely to present late to HIV/AIDS care compared with those who disclosed their HIV status, studies done elsewhere [9,12] supports this finding. This could be explained that the desire to hide one's HIV-positive status from a spouse may inhibit HIV care-seeking.…”

Section: Discussionmentioning

confidence: 77%

Factors associated with late presentation to HIV/AIDS care in South Wollo ZoneEthiopia: a case-control study

Abaynew¹,

Deribew

Deribe³

2011

AIDS Res Ther

104

111

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BackgroundAccess to free antiretroviral therapy in Sub-Saharan Africa has been steadily increasing. The success of large-scale antiretroviral therapy programs depends on early initiation of HIV/AIDs care. The purpose of the study was to examine factors associated with late presentation to HIV/AIDS care.MethodsA case-control study was conducted in Dessie referral and Borumeda district hospitals from March 1 to 31, 2010, northern Ethiopia. A total of 320 study participants (160 cases and 160 controls) were included in the study. Cases were people living with HIV/AIDS (PLHA) who had a WHO clinical stage of III or IV or a CD4 lymphocyte count of less than 200/uL at the time of the first presentation to antiretroviral treatment (ART) clinics. Controls were PLHA who had WHO stage I or II or a CD4 lymphocyte count of 200/uL or more irrespective of clinical staging at the time of first presentation to the ART clinics of the hospitals cases and controls were interviewed by trained nurses using a pre-tested and structured questionnaire. In-depth interviews were conducted with ten health workers and eight PLHA.ResultsPLHA who live with their families [OR = 3.29, 95%CI: 1.28-8.45)], lived in a rented house [OR = 2.52, 95%CI: 1.09-5.79], non-pregnant women [OR = 9.3, 95% CI: 1.93-44.82], who perceived ART have many side effects [OR = 6.23, 95%CI:1.63,23.82)], who perceived HIV as stigmatizing disease [OR = 3.1, 95% CI: 1.09-8.76], who tested with sickness/symptoms [OR = 2.62, 95% CI: 1.26-5.44], who did not disclose their HIV status for their partner [OR = 2.78, 95% CI: 1.02-7.56], frequent alcohol users [OR = 3.55, 95% CI: 1.63-7.71] and who spent more than 120 months with partner at HIV diagnosis[OR = 5.86, 95% CI: 1.35-25.41] were significantly associated with late presentation to HIV/AIDS care. The qualitative finding revealed low awareness, non-disclosure, perceived ART side effects and HIV stigma were the major barriers for late presentation to HIV/AIDS care.ConclusionsEfforts to increase early initiation of HIV/AIDS care should focus on addressing patient's concerns such as stigma, drug side effects and disclosure.

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“…A prospective study from New York City found significantly higher rates of TB, AIDS, and death for substance users on welfare than for the general population of New York City (risk ratios of 15, 10, and 5, respectively) (100). In addition, HIV-infected persons living in resource-constrained settings face socioeconomic and behavioral barriers to HIV testing and access to antiretroviral treatment (16). Without adequate urban planning and investment in equitable urban health care systems, including integrated TB and HIV programs, the rise in slum areas and urban poverty will continue to propel the transmission of HIV-associated TB and its associated morbidity and mortality.…”

Section: Urban Population Growth May Escalate the Hiv And Tb Syndemicmentioning

confidence: 99%

HIV and Tuberculosis: a Deadly Human Syndemic

2011

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SUMMARY A syndemic is defined as the convergence of two or more diseases that act synergistically to magnify the burden of disease. The intersection and syndemic interaction between the human immunodeficiency virus (HIV) and tuberculosis (TB) epidemics have had deadly consequences around the world. Without adequate control of the TB-HIV syndemic, the long-term TB elimination target set for 2050 will not be reached. There is an urgent need for additional resources and novel approaches for the diagnosis, treatment, and prevention of both HIV and TB. Moreover, multidisciplinary approaches that consider HIV and TB together, rather than as separate problems and diseases, will be necessary to prevent further worsening of the HIV-TB syndemic. This review examines current knowledge of the state and impact of the HIV-TB syndemic and reviews the epidemiological, clinical, cellular, and molecular interactions between HIV and TB.

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Obstacles and Proposed Solutions to Effective Antiretroviral Therapy in Resource-Limited Settings

Cited by 14 publications

References 28 publications

Access to antiretroviral therapy among HIV/AIDS patients in Chiang Mai province, Thailand

Access to antiretroviral therapy among HIV/AIDS patients in Chiang Mai province, Thailand

Factors associated with late presentation to HIV/AIDS care in South Wollo ZoneEthiopia: a case-control study

HIV and Tuberculosis: a Deadly Human Syndemic

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