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Resistance to Anti-HIV Drugs in Uganda Developed Due to Drug Supply Problems

Some HIV-infected patients in Uganda who self-paid for their antiretroviral medications experienced interruptions in drug supply due to either financial// demands or supply logistical disruptions. These treatment interruptions led to the development of resistance to antiretroviral medications in patients.

These findings by a team led by researchers at the Infectious Diseases Institute at Makerere University, Kampala, and UCSF are reported in the April 22, 2007 issue of the journal "AIDS."

"We have found the concern is not about the occasional missed dose—most of the patients had near perfect adherence and full suppression of the virus— but about supply interruptions that led to longer multi-day treatment interruptions allowing resistance to develop," said study lead author Jessica Oyugi, MD, from the Infectious Diseases Institute at Makerere University, Kampala, Uganda.

The study followed just under 100 patients who self paid for generic fixed-dose antiretroviral formulations. Findings showed that medications were very effective at suppressing the virus, with full viral suppression in over 80 percent of people on treatment for 6 months. Resistance developed in people during treatment interruptions, and 90 percent of all missed doses were due to treatment interruptions as opposed to the occasional skipped dose. Further, almost 50 percent of the participants interrupted treatment due to financial difficulties. In addition, at one point during the study period, supply of one product was halted due to customs issues. A two-week nationwide shortage resulted that created gaps in treatment for some individuals taking that medication.

"In a context where the ability of poor people to adhere to medications regimens has been questioned, the issue is not so much about behavioral strategies to increase adherence, but about structural failures that interrupt access to treatment. Free access to treatment leads to better survival th
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