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ARV dropouts down with comprehensive care
01 September 2006. IRIN PlusNews. Republished courtesy of IRIN PlusNews.
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A high level of adherence to life-prolonging anti-retroviral (ARV) medication is possible even among poor, uneducated communities, as long as comprehensive HIV/AIDS care is provided, according to health workers.
Comprehensive HIV/AIDS care includes counselling, nutritional assistance, support groups and follow-up. According to Dr Marjory Waweru, who runs the African Medical Research Foundation (Amref) community health centre in Kibera, the largest slum in the Kenyan capital, Nairobi, 90 percent of patients receiving comprehensive care adhered to their ARV regimens.
"Because most of our patients are uneducated, we place a lot of emphasis on counselling them on the importance of sticking to their drug regimens," she said. "We make sure they know that the drugs are for life, and missing a day here or there could jeopardise their survival."
Failure to take ARVs regularly and at specified times may reduce their effectiveness and lead to the development of drug-resistant HIV strains, hastening progression from HIV to Aids. The drugs often have unpleasant side effects, such as nausea, and may increase appetite, causing poor patients to abandon their medication if they cannot afford more food, especially if the drugs are not free of charge.
Waweru stressed that for any ARV programme to succeed in impoverished circumstances, it had to provide more than just free drugs. The Amref centre, funded by the United States Centers For Disease Control, offers counselling, regular follow-up by community health workers, free treatment of opportunistic infections, and gives more than 500 patients each 5kg of fortified flour every month. "We build their confidence and they are able to remain on the drugs, knowing they have food and that if they fall sick they can get treatment."
George Olali tested positive for HIV in 1998 and was virtually on his deathbed when he was placed on ARVs, but they were so expensive that he had to abandon the regimen. Today, "with the support groups and the free food and ARVS, I can be sure I will continue to live a productive life."
ARV compliance is high at the Kibera clinic run by Medecins Sans Frontieres, the international medical charity, but staff feel it could be higher. "It can be difficult to provide services to people here - many refuse to start antiretroviral treatment because they know they cannot faithfully adhere to it," Florencia Maghanga, the nurse in charge told PlusNews. "They often travel to find work in order to afford the food they need and could be gone for days, interrupting their treatment."
A recent study in rural Uganda, published in the Lancet medical journal in August, study used comprehensive care to support adherence and achieved lower viral loads in participants. It recommended that healthcare providers work on ways to overcome barriers to comprehensive Aids care programmes, such as patients having transport problems to health centres in rural Africa and having to pay for ARVs, which led to worse treatment outcomes.
This item is delivered to the English Service of the United Nations' Humanitarian Information Unit but, may not necessarily reflect the views of the UN. |
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