Too many stop taking their HIV treatment: Here's what we can do about it I Medicines for Africa
medicines for africa (mfa)
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Despite treatment programmes being so successful, we still see advanced HIV because of disengagements from antiretroviral care. So why do people stop taking their HIV treatment and what we can do about it? Graeme Meintjes and his colleagues recommend differentiated care which is in essence treating people differently according to their needs. They advocate that we create more optimized differentiated services to improve quality of care by addressing key issues that causes people to disengage from treatment in the first place. For instance, giving people longer refills of up to six months with yearly clinical reviews for individuals who are clinically well and are suppressing their viral load well to reduce the need for more frequent clinic visits and providing flexibility so that people can pick up their medication elsewhere in cases of unexpected travel.
Stopping antiretroviral treatment when you are living with HIV can result in increased HIV transmission, illness, hospitalisation, and eventually death.?Despite this progress, HIV remains a frequent cause of premature death and hospital admission among adults in South Africa other African countries.?People are diagnosed with HIV, start antiretrovirals, but then after variable periods of time stop attending their clinic and stop taking their antiretrovirals. Reasons for disengagement vary from person to person and can be complex. Studies have identified?the fact that people move around a lot?and?inflexibility of the healthcare system?as large contributors.?This may result in people who disengage rapidly becoming vulnerable to severe opportunistic infections that may result in preventable hospitalisations and deaths. Stopping treatment also increases the likelihood of?onward transmission of HIV, as it results in a person’s HIV viral load increasing, which makes them more likely to transmit infection.
To solve this problem, Graeme Meintjes and his colleagues are recommending differentiated care which is in essence treating people differently according to their needs. For example, the needs of a a very ill person who just got diagnosed are quite different from those of someone who has been on antiretrovirals for years and is in good health. To help people on ARV stay on treatment for longer periods of time, differentiated models of care have been tested, developed and scaled up. These models entail reducing the frequency of visits to clinics, longer medication refills, having community collection points to bring medication closer to where people live and peer support with adherence to treatment and refills.
The authors recommend that more should be done to increase scale and create more optimal differentiated services. Improvements should aim to address the issues that causes people to disengage from treatment in the first place. For instance, giving people longer refills of up to six months with yearly clinical reviews for individuals who are clinically well and are suppressing their viral load well would reduce the need for frequent clinic visits. Amongst other things the authors call for better trace and recall systems as well as adapting the system to have flexibility that allows patients to pick up their medication elsewhere during unanticipated travel or to make it easier for people to collect their medication later than initially previewed. Ultimately, what is needed is for healthcare to remain open to learning and to do more to educate and support patients and communities to stay on treatment so that the benefits of investment in HIV treatment can be realized with people clinging with HIV having better quality of life.
Read the article: https://www.spotlightnsp.co.za/2024/10/03/why-people-stop-taking-their-hiv-treatment-and-what-we-can-do-about-it/
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Freelance consultant, HEOR
1 个月Under the table payments requested to obtain the drug? Even when drugs are ‘nominally’ free.
Well Oiled Machine by University of the Western Cape
1 个月I like the recommendations by the author, I am working on a system to educate patients how to remember to take their meds daily this includes setting up alarms on their phones that will remind them that it is time to take their meds, another recommendation would be to put the meds where you put your house keys, where you put your toothbrush and toothpaste etc… so you will never fail on adherence 2. SMS systems to remind patients that their medication is ready for collection, particularly the ART treatment…
Well Oiled Machine by University of the Western Cape
1 个月Other issues could be the socioeconomic impact on these individuals But great observation
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1 个月Useful tips