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首页> 外文期刊>AIDS care. >Hunger, waiting time and transport costs: time to confront challenges to ART adherence in Africa.
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Hunger, waiting time and transport costs: time to confront challenges to ART adherence in Africa.

机译：饥饿，等待时间和运输成本：是时候面对非洲抗逆转录病毒疗法加入的挑战。

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Adherence levels in Africa have been found to be better than those in the US. However around one out of four ART users fail to achieve optimal adherence, risking drug resistance and negative treatment outcomes. A high demand for 2nd line treatments (currently ten times more expensive than 1st line ART) undermines the sustainability of African ART programs. There is an urgent need to identify context-specific constraints to adherence and implement interventions to address them. We used rapid appraisals (involving mainly qualitative methods) to find out why and when people do not adhere to ART in Uganda, Tanzania and Botswana. Multidisciplinary teams of researchers and local health professionals conducted the studies, involving a total of 54 semi-structured interviews with health workers, 73 semi-structured interviews with ARTusers and other key informants, 34 focus group discussions, and 218 exit interviews with ART users. All the facilities studied in Botswana, Tanzania and Uganda provide ARVs free of charge, but ART users report other related costs (e.g. transport expenditures, registration and user fees at the private health facilities, and lost wages due to long waiting times) as main obstacles to optimal adherence. Side effects and hunger in the initial treatment phase are an added concern. We further found that ART users find it hard to take their drugs when they are among people to whom they have not disclosed their HIV status, such as co-workers and friends. The research teams recommend that (i) health care workers inform patients better about adverse effects; (ii) ART programmes provide transport and food support to patients who are too poor to pay; (iii) recurrent costs to users be reduced by providing three-months, rather than the one-month refills once optimal adherence levels have been achieved; and (iv) pharmacists play an important role in this follow-up care.
机译：已发现非洲的遵守率要高于美国。然而，大约四分之一的抗逆转录病毒疗法使用者未能达到最佳依从性，存在耐药性和治疗结果阴性的风险。对二线治疗的高需求（目前价格比一线ART高十倍）破坏了非洲ART计划的可持续性。迫切需要确定特定于上下文的约束条件并实施干预措施以解决这些问题。我们使用快速评估（主要涉及定性方法）来找出为什么和何时人们在乌干达，坦桑尼亚和博茨瓦纳不遵守抗逆转录病毒疗法。由研究人员和当地卫生专业人员组成的多学科团队进行了研究，涉及与卫生工作者进行的总共54次半结构化访谈，对ARTusers和其他主要信息提供者的73次半结构化访谈，34个焦点小组讨论以及对ART用户的218次退出访谈。在博茨瓦纳，坦桑尼亚和乌干达研究的所有设施均免费提供抗逆转录病毒药物，但抗病毒药物使用者报告了其他相关费用（例如，运输支出，私人卫生设施的注册和使用者费用以及由于等待时间长而导致的工资损失）是主要障碍达到最佳依从性。在初始治疗阶段的副作用和饥饿感是一个额外的关注点。我们进一步发现，ART使用者在同事和朋友等尚未公开HIV感染状况的人群中发现难以服用药物。研究小组建议（i）医护人员更好地告知患者不良反应; （ii）ART方案为太贫穷而无力支付费用的患者提供运输和食物支持; （iii）通过达到三个月而不是一个月补充一次来减少用户的经常性费用，一旦达到最佳遵守水平; （iv）药剂师在此后续护理中扮演重要角色。

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