E-DRUG: ART scale up challenges (2)
-----------------------------------
In response to Alemayehu Lemma's query about less-than-optimal uptake of
antiretroviral therapy (ART) even when the services are available, we
need to think about multiple factors that prevent access or interfere
with uptake.
There is growing evidence that shows the serious importance of community
engagement for increased uptake of HIV testing, prevention and ART and
for support of adherence to ART once started. Health workers and systems
for medical care do not generally have the capacity to tackle the social
and economic issues that affect uptake, or even for much community
education to inform people about treatment and care for people with HIV.
There is therefore urgent need to develop partnerships with community
and civil society bodies to achieve the goals of universal access and
life-long support for treatment of HIV (and many other diseases) as a
chronic condition.
As an example, a partnership between community organizations and the
government health system in Zambia is based on a shared acknowledgement
that uptake in ARV programmes needed to take into account the major
concerns of the people who need treatment, such as:
* food, especially in the first six months of treatment when people are
too ill to work;
* transport problems making repeated access to clinics difficult;
* lack of information in the community and much misinformation about HIV
and ARV therapy;
* the necessity of life-long adherence and fears about continuity of
drug supplies;
* fears about side effects, disclosure, reproductive health, prevention,
stigma and discrimination.
A community engagement project to support the government ARV programme
has been running in two peri-urban sites for the last two years. HIV
positive people work as patient advocates and treatment supporters,
based in the government ARV clinics. Others provide community education
on HIV, prevention and ART in community settings, at market places and
other community centres. They work closely with traditional healers and
with home based care workers, who provide adherence support to families
and individuals and encourage disease prevention for HIV positive
people. All project partners use a common (paper-based) referral system
and liaise with local and ART clinics to ensure patient follow-up. The
success of this approach has encouraged scaling up of the model in other
districts of Zambia.
This is only one model - a number of others also exist, and the results
commonly observed are that uptake is increased, ART outcomes are
improved and health staff have increased confidence that patients are
followed-up and their medical care has lasting effects. Another
important health systems effect we have seen is that where there are
informed community members involved with ART service delivery, health
workers are able to get support for their own health concerns - a major
issue in high-prevalence HIV settings where deaths of health staff due
to HIV are nearly equal to losses due to migration and 'brain drain'.
Carolyn Green
Senior Technical Advisor, Care & Support
Care & Impact Mitigation Team
International HIV/AIDS Alliance
104-106 Queens Road
Brighton BN1 3XF
United Kingdom
direct phone: +44 1273 718747
main phone: +44 1273 718900
cellphone: +44 773311 2368
cgreen@aidsalliance.org