Antiretroviral treatment failure due to lack of patient support

A new report to be presented at the Toronto International AIDS Conference shows that access to antiretrovirals is only part of the treatment equation.

Without targeted patient support, the report finds, patients may not take their medicines regularly and frequently enough, thereby nullifying the therapeutic benefits of treatment.

Released by the World Health Organization (WHO), the University of Amsterdam, and the Royal Tropical Institute of the Netherlands, the report "From Access to Adherence: the Challenges of Antiretroviral Treatment", exposes the tough realities faced daily by people living with HIV and AIDS in Botswana, Tanzania and Uganda. The report identifies the reasons for adherence failure and provides a series of practical recommendations to improve the situation.

The optimal adherence rate for antiretroviral therapy is 95%, as recommended by WHO. Lack of adherence to therapy has serious public health consequences, such as treatment failure, the spread of drug resistance and the waste of resources. The report finds that individuals trying to take all of their medicines are often trapped in a vicious circle of social, economic and workplace obstacles hampering their adherence to treatment.

Out of a sample 514 patients interviewed in Botswana, 23% were taking less than the critical 95% of dosage. In Tanzania, 79% of the 207 patients interviewed were below the critical level.

Reasons found for adherence failure were: alcohol or substance abuse; work-related problems such as not getting time off to go to the clinic or stigma in the workplace; long travel time to clinics and long waits at the end; stigma and discrimination in the community and at home. In Uganda, it is common for people to stop their medication because they cannot afford the food they need to eat when taking the drugs; distance to health facilities and the costs related to life-long treatment were also cited by study participants.

The report's research teams propose specific priorities for immediate implementation:

• Enforcement of legislation to protect the rights of workers to access to treatment without fear of discrimination
• Training and supporting community counsellors who operate from home
• Waiving registration and consultation fees at health clinics for those on antiretroviral therapy
• Providing food support for antiretroviral users, particularly at the beginning of treatment, when appetite increases
• Examining the possibility of a transport voucher scheme for people who cannot afford to go and pick up their medicines.

Overview of antiretroviral therapy in Botswana, Tanzania and Uganda, 2005

*Source: "From Access to Adherence", p2, Anita Hardon et al, © World Health organization 2006
**For this table the authors refer to WHO/UNAIDS '3 by 5' Report of 2006 and the UNAIDS 2006 Report on the Global AIDS Epidemic."