Tasks and Strategies of Self-Management of Living with Antiretroviral Therapy in Uganda

Abstract

There is increasing interest in promoting and supporting self-management of HIV and antiretroviral treatment (ART), including in resource-limited settings. Although the impact of HIV and ART on people in Uganda has been explored, little attention has been paid to how people self-manage. This qualitative study collected data from 20 participants on ART in Wakiso district, Uganda, using in-depth interviews, life histories, and observations to explore the tasks and strategies of living with ART. The identified strategies were compared to two existing self-management frameworks. Results highlighted a range of tasks including obtaining, taking, and adhering to ART medication, monitoring their condition, living with stigma and managing disclosure, maintaining general health, and adjusting to new roles. Participants described a range of strategies or behaviors to manage, which they actively created and used, tailored to their needs and environment. Comparison with existing frameworks revealed many similarities, with some local differences in enactment, and greater emphasis in our sample on obtaining the medication. Interventions to support people with self-management in Uganda, and possibly other resource-limited settings, require careful adaptation to local settings. The degree to which each of these strategies may improve health and quality of life requires further investigation.

The Role of a Pharmacist in the Analysis of Adherence Rates and Associated Factors in HIV-Patients Registered on Centralized Chronic Medicines Dispensing and Distribution (CCMDD) Programme in the Public Sector in South Africa

“…The average time spent in each area was that the mean waiting time (minutes) at reception was 1.47 ± 0.67 ranging from 1-90, nurses station: 1.33 ± 0.47 ranging from 1-30. The waiting areas associated with poor ARV adherence were at reception and these results concurred with studies done by authors [27,28] and pharmacy as already stated, though in other studies the waiting times at pharmacy were not associated with poor adherence with p = 0.43. In this case it is expected that patients wait longer at reception due to the many processes the patients have to go through coupled with shortage of staff for the longer waiting times to collect their medicines from pharmacy is due to shortage of staff.…”

“…Long waiting times and limited clinic hours were reported to lead to non-adherence, especially for employed people who would need to take time off to collect their medication [26,27]. The waiting times in different areas of the clinic were also assessed in this study.…”

Routines, Hope, and Antiretroviral Treatment among Men and Women in Uganda

“…Patients have developed specific routines and practices to manage HIV in response to clinical instructions and education. This element of self-care shows management of the disease within the physical spaces of the home, as has been emerging in Uganda with treatment rollout (Martin et al 2013). Our respondents knew their medication routines and embedded the medication into daily practices, surrounding work and movements around the home.…”

“…Our respondents knew their medication routines and embedded the medication into daily practices, surrounding work and movements around the home. This is part of daily self-care and integral to long-term illness management (Martin et al 2013). Additionally, as Michael the boda boda driver demonstrated, these practices have symbolic significance.…”

“…In Uganda, Martin et al (2013) examined the dimensions of self-management required for ongoing adherence to ART. They found patients were attuned to the multiple responsibilities of obtaining and taking medication, managing illnessrelated identities, and monitoring their health.…”