TY - JOUR
T1 - Inadequate pre-antiretroviral care, stock-out of antiretroviral drugs and stigma
T2 - Policy challenges/bottlenecks to the new WHO recommendations for earlier initiation of antiretroviral therapy (CD<350 cells/μL) in eastern Uganda
AU - Muhamadi, Lubega
AU - Nsabagasani, Xavier
AU - Tumwesigye, Mbona Nazarius
AU - Wabwire-Mangen, Fred
AU - Ekström, Anna Mia
AU - Peterson, Stefan
AU - Pariyo, George
PY - 2010/10
Y1 - 2010/10
N2 - Objective: This study explores reasons for late ART initiation among known HIV positive persons in care from a client/caretaker perspective in eastern Ugandan where ART awareness is presumably high yet AIDS related mortality is a common function of late initiation of ARVs. Methods: In Iganga, Uganda we conducted in-depth interviews with clients who started ART at 50-200 CD4 cells/μL and those initiated very late at CD4<50 cells/μL. Focus-group discussions were also conducted with caretakers of clients on ART. Content analysis was performed to identify recurrent themes. Results: ARV stock-outs, inadequate pre-antiretroviral care and lack of staff confidentiality were system barriers to timely ART initiation. Weak social support and prevailing stigma and misconceptions about ARVs as drugs designed to kill, cause cancer, infertility or impotence were other important factors. Conclusion: If the new WHO recommendations (start ART at CD4 350 cells/μL) should be feasible, PLHIV/communities need sensitization about the importance of regular pre-ARV care through the local media and authorities. The ARV supply chain and staff attitudes towards client confidentiality must also be improved in order to encourage timely ART initiation. PLHIV/communities should be sensitization about drug package labeling and the use and importance of ARVs. Stronger social support structures must be created through public messages that fight stigma, enhance acceptance of PLHIV and encourage timely ART initiation.
AB - Objective: This study explores reasons for late ART initiation among known HIV positive persons in care from a client/caretaker perspective in eastern Ugandan where ART awareness is presumably high yet AIDS related mortality is a common function of late initiation of ARVs. Methods: In Iganga, Uganda we conducted in-depth interviews with clients who started ART at 50-200 CD4 cells/μL and those initiated very late at CD4<50 cells/μL. Focus-group discussions were also conducted with caretakers of clients on ART. Content analysis was performed to identify recurrent themes. Results: ARV stock-outs, inadequate pre-antiretroviral care and lack of staff confidentiality were system barriers to timely ART initiation. Weak social support and prevailing stigma and misconceptions about ARVs as drugs designed to kill, cause cancer, infertility or impotence were other important factors. Conclusion: If the new WHO recommendations (start ART at CD4 350 cells/μL) should be feasible, PLHIV/communities need sensitization about the importance of regular pre-ARV care through the local media and authorities. The ARV supply chain and staff attitudes towards client confidentiality must also be improved in order to encourage timely ART initiation. PLHIV/communities should be sensitization about drug package labeling and the use and importance of ARVs. Stronger social support structures must be created through public messages that fight stigma, enhance acceptance of PLHIV and encourage timely ART initiation.
KW - Bottlenecks
KW - Policy challenges
KW - WHO ART Recommendations
UR - http://www.scopus.com/inward/record.url?scp=77956171313&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=77956171313&partnerID=8YFLogxK
U2 - 10.1016/j.healthpol.2010.06.003
DO - 10.1016/j.healthpol.2010.06.003
M3 - Article
C2 - 20615573
AN - SCOPUS:77956171313
SN - 0168-8510
VL - 97
SP - 187
EP - 194
JO - Health policy
JF - Health policy
IS - 2-3
ER -