They also found that about one in three patients had increases in the level of virus in the blood consistent with treatment failure, and not surprisingly, the patients who were not taking their drugs were more likely to have treatment failure.
Another quite interesting finding was that being public about their HIV status was associated with suppression of virus, Ramadhani said. There still is a substantial stigma associated with HIV in Africa. It is likely that individuals infected with HIV who discussed their disease with friends or family members are likely living in supportive environments that promote adherence.
The researchers also found that the farther away patients were from the clinic, the less likely they would take their drugs as instructed.
This study has identified critical factors that affect the success of antiretroviral therapy programs in Africa, and we believe that these findings should be incorporated by policy makers into practice, said Dukes John Crump, M.B., Ch.B, who specializes in infectious diseases and international health and is a senior member of the research team. These drugs, which are known to work, should be free and readily available.
Structural barriers to care, such as the distance to clinics and especially the burden of patients paying for their medication, must be removed, Crump continued. Social coping, including the disclosure of HIV status to people to family and friends leads to better adherence to medication and lower rates of treatment failure.
According to Michael H., Merson. M.D., director of the Duke Global Health Institute, "This study nicely illustrates some of the factors that need to be considered in red
|Contact: Richard Merritt|
Duke University Medical Center