• Conceptions of Agency and Constraint for HIV-Positive Patients and Healthcare Workers to Support Long-Term Engagement With Antiretroviral Therapy Care in Khayelitsha, South Africa

      Stern, E; Colvin, C; Gxabagxaba, N; Schutz, C; Burton, R; Meintjes, G (Taylor & Francis, 2017-03-01)
      In the context of the optimism around antiretroviral therapy (ART) as prevention of HIV/AIDS, addressing the barriers to long-term ART adherence is critical. This is particularly important given the tendency to individualise or use a blame discourse when exploring why HIV-infected patients "fail" to adequately adhere to ART, and not sufficiently exploring contextual reasons for poor adherence that may require varying solutions. This study took place at three clinics and one hospital in Khayelitsha, South Africa, to document the contextual factors that challenged ART adherence in this community. Interviews were conducted with 20 HIV-infected patients who had defaulted on their ART and were subsequently admitted to Khayelitsha hospital for clinical complications, and 9 ART service providers including doctors, nurses and HIV counsellors. Interviews assessed the reasons patients defaulted on ART and explored ways this could be prevented. Data from both groups were analysed collectively using thematic analysis. While the interviews revealed a landscape of environmental risks threatening adherence to ART, all patients managed to overcome the identified barriers at some point in their treatment phase, indicating the fluidity of patients' needs and decision making. Patients reported that distrustful relationships with service providers could inhibit their understanding of ART and/or interrupt their follow-up at clinics. Patients described their rationale and agency underlying non-adherence, such as testing their bodies' physical limits without ART medication. The study speaks to the need to appreciate contextual social and structural barriers related to ART adherence, and how these are negotiated differently by specific sub-groups, to support an appropriate response. It is imperative to not solely emphasise loss to follow-up but also assess patients' subjective trajectory of their ART journey, decision making and agency with adhering to ART, their relations with healthcare workers, and how these dynamics are intertwined with broader constraints in health systems.
    • Monitoring HIV Viral Load in Resource Limited Settings: Still a Matter of Debate?

      Arnedo, M; Alonso, E; Eisenberg, N; Ibáñez, L; Ferreyra, C; Jaén, A; Flevaud, L; Khamadi, S; Roddy, P; Gatell, JM; et al. (Public Library of Science, 2012-12-06)
      Consequences of lack of viral monitoring in predicting the effects of development of HIV drug resistance mutations during HAART in resource-limited settings (RLS) is still a matter of debate.
    • Promoting long term adherence to Antiretroviral Treatment

      Mills, Edward J; Lester, Richard; Ford, Nathan (2012-06-28)
    • Providing antiretroviral care in conflict settings.

      Mills, Edward J; Ford, Nathan; Singh, Sonal; Eyawo, Oghenowede; BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada. emills@cfenet.ubc.ca (2009-11)
      There has been an historic expectation that delivering combination antiretroviral therapy (cART) to populations affected by violent conflict is untenable due to population movement and separation of drug supplies. There is now emerging evidence that cART provision can be successful in these populations. Using examples from Médecins Sans Frontières experience in a variety of African settings and also local nongovernmental organizations' experiences in northern Uganda, we examine novel approaches that have ensured retention in programs and adequate adherence. Emerging guidelines from United Nations bodies now support the expansion of cART in settings of conflict.
    • Public health. Getting HIV treatment to the most people.

      Lynch, Sharonann; Ford, Nathan; van Cutsem, Gilles; Bygrave, Helen; Janssens, Bart; Decroo, Tom; Andrieux-Meyer, Isabelle; Roberts, Teri; Balkan, Suna; Casas, Esther; et al. (2012-07-20)
    • Treatment outcomes from the largest antiretroviral treatment program in Myanmar (Burma): a cohort analysis of retention after scale-up.

      Sabapathy, Kalpana; Ford, Nathan; Chan, Khin Nyein; Kyaw, Moe Kyaw; Elema, Riekje; Smithuis, Frank; Floyd, Sian; Imperial College London, London, United Kingdom; Medecins Sans Frontieres, Amsterdam, The Netherlands, Medecins Sans Frontieres, Geneva, Switzerland; Medecisn Sans Frontieres, Yangon, Myanmar; Medical Action Myanmar, Yangon, Myanmar; London School of Hygiene and Tropical Medicine, London, United Kingdom. (2012-06-01)
      Antiretroviral treatment (ART) coverage in Myanmar is well below average. This study describes retention and baseline predictors of prognosis from the largest ART program in the country.
    • Treatment outcomes of patients on Second-line Antiretroviral Therapy in resource-limited settings: A Systematic Review and Meta-Analysis

      Ajose, Olawale; Mookerjee, Siddharth; Mills, Edward J; Boulle, Andrew; Ford, Nathan; Clinton Health Access Initiative, Dar es Salaam, Tanzania. (2012-05-15)
      A growing proportion of patients on antiretroviral therapy in resource-limited settings have switched to second-line regimens. We carried out a systematic review in order to summarize reported rates and reasons for virological failure among people on second-line therapy in resource-limited settings.