Barriers to antiretroviral therapy adherence in rural Mozambique
Identifieur interne : 003E44 ( Main/Curation ); précédent : 003E43; suivant : 003E45Barriers to antiretroviral therapy adherence in rural Mozambique
Auteurs : Kate Groh [États-Unis] ; Carolyn M. Audet [États-Unis] ; Alberto Baptista [États-Unis] ; Mohsin Sidat ; Alfredo Vergara [États-Unis] ; Sten H. Vermund [États-Unis] ; Troy D. Moon [États-Unis]Source :
- BMC Public Health [ 1471-2458 ] ; 2011.
Abstract
HIV is treated as a chronic disease, but high lost-to-follow-up rates and poor adherence to medication result in higher mortality, morbidity, and viral mutation. Within 18 clinical sites in rural Zambézia Province, Mozambique, patient adherence to antiretroviral therapy has been sub-optimal.
To better understand barriers to adherence, we conducted 18 community and clinic focus groups in six rural districts. We interviewed 76 women and 88 men, of whom 124 were community participants (CP; 60 women, 64 men) and 40 were health care workers (HCW; 16 women, 24 men) who provide care for those living with HIV.
While there was some consensus, both CP and HCW provided complementary insights. CP focus groups noted a lack of confidentiality and poor treatment by hospital staff (42% CP vs. 0% HCW), doubt as to the benefits of antiretroviral therapy (75% CP vs. 0% HCW), and sharing medications with family members (66% CP vs. 0%HCW). Men expressed a greater concern about poor treatment by HCW than women (83% men vs. 0% women). Health care workers blamed patient preference for traditional medicine (42% CP vs. 100% HCW) and the side effects of medication for poor adherence (8% CP vs. 83% CHW).
Perspectives of CP and HCW likely reflect differing sociocultural and educational backgrounds. Health care workers must understand community perspectives on causes of suboptimal adherence as a first step toward effective intervention.
Url:
DOI: 10.1186/1471-2458-11-650
PubMed: 21846344
PubMed Central: 3171727
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Mohsin Sidat<affiliation><nlm:aff id="I5">Ministry of Health, Av. Quelimane: Av. 1 de Julho, Predio deo Monte Giro, Quelimane, Moçambique</nlm:aff><wicri:noCountry code="subfield">Moçambique</wicri:noCountry></affiliation><affiliation><nlm:aff id="I6">Faculty of Medicine, University Eduardo Mondlane, PO Box 257, Maputo, Moçambique</nlm:aff><wicri:noCountry code="subfield">Moçambique</wicri:noCountry></affiliation><affiliation><nlm:aff id="I6">Faculty of Medicine, University Eduardo Mondlane, PO Box 257, Maputo, Moçambique</nlm:aff><wicri:noCountry code="subfield">Moçambique</wicri:noCountry></affiliation><affiliation><nlm:aff id="I6">Faculty of Medicine, University Eduardo Mondlane, PO Box 257, Maputo, Moçambique</nlm:aff><wicri:noCountry code="subfield">Moçambique</wicri:noCountry></affiliation><affiliation><nlm:aff id="I7">Friends in Global Health, Avenida dos Trabalhadores N°424, Quelimane, Moçambique</nlm:aff><wicri:noCountry code="subfield">Moçambique</wicri:noCountry></affiliation><affiliation><nlm:aff id="I7">Friends in Global Health, Avenida dos Trabalhadores N°424, Quelimane, Moçambique</nlm:aff><wicri:noCountry code="subfield">Moçambique</wicri:noCountry></affiliation><affiliation><nlm:aff id="I6">Faculty of Medicine, University Eduardo Mondlane, PO Box 257, Maputo, Moçambique</nlm:aff><wicri:noCountry code="subfield">Moçambique</wicri:noCountry></affiliation><affiliation><nlm:aff id="I7">Friends in Global Health, Avenida dos Trabalhadores N°424, Quelimane, Moçambique</nlm:aff><wicri:noCountry code="subfield">Moçambique</wicri:noCountry></affiliation><affiliation><nlm:aff id="I7">Friends in Global Health, Avenida dos Trabalhadores N°424, Quelimane, Moçambique</nlm:aff><wicri:noCountry code="subfield">Moçambique</wicri:noCountry></affiliation>Le document en format XML
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Quelimane: Av. 1 de Julho, Predio deo Monte Giro, Quelimane, Moçambique</nlm:aff><wicri:noCountry code="subfield">Moçambique</wicri:noCountry></affiliation><affiliation><nlm:aff id="I6">Faculty of Medicine, University Eduardo Mondlane, PO Box 257, Maputo, Moçambique</nlm:aff><wicri:noCountry code="subfield">Moçambique</wicri:noCountry></affiliation></author><author><name sortKey="Vergara, Alfredo" sort="Vergara, Alfredo" uniqKey="Vergara A" first="Alfredo" last="Vergara">Alfredo Vergara</name><affiliation wicri:level="2"><nlm:aff id="I2">Department of Preventive Medicine, Village at Vanderbilt, Suite 2100,1500 21st Avenue South Nashville, TN 37212, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Preventive Medicine, Village at Vanderbilt, Suite 2100,1500 21st Avenue South Nashville, TN 37212</wicri:regionArea><placeName><region type="state">Tennessee</region></placeName></affiliation><affiliation wicri:level="1"><nlm:aff id="I3">Vanderbilt Institute for Global Health, 2525 West End Ave, Suite 750, 2525 West End Ave, Nashville, TN, 37203, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Vanderbilt Institute for Global Health, 2525 West End Ave, Suite 750, 2525 West End Ave, Nashville, TN, 37203</wicri:regionArea><wicri:noRegion>37203</wicri:noRegion></affiliation></author><author><name sortKey="Vermund, Sten H" sort="Vermund, Sten H" uniqKey="Vermund S" first="Sten H" last="Vermund">Sten H. 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Audet</name><affiliation wicri:level="2"><nlm:aff id="I2">Department of Preventive Medicine, Village at Vanderbilt, Suite 2100,1500 21st Avenue South Nashville, TN 37212, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Preventive Medicine, Village at Vanderbilt, Suite 2100,1500 21st Avenue South Nashville, TN 37212</wicri:regionArea><placeName><region type="state">Tennessee</region></placeName></affiliation><affiliation wicri:level="1"><nlm:aff id="I3">Vanderbilt Institute for Global Health, 2525 West End Ave, Suite 750, 2525 West End Ave, Nashville, TN, 37203, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Vanderbilt Institute for Global Health, 2525 West End Ave, Suite 750, 2525 West End Ave, Nashville, TN, 37203</wicri:regionArea><wicri:noRegion>37203</wicri:noRegion></affiliation></author><author><name sortKey="Baptista, Alberto" sort="Baptista, Alberto" uniqKey="Baptista A" first="Alberto" last="Baptista">Alberto Baptista</name><affiliation wicri:level="2"><nlm:aff id="I4">Department of Pediatrics, 2200 Children's Way, Nashville, TN 37232, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Pediatrics, 2200 Children's Way, Nashville, TN 37232</wicri:regionArea><placeName><region type="state">Tennessee</region></placeName></affiliation></author><author><name sortKey="Sidat, Mohsin" sort="Sidat, Mohsin" uniqKey="Sidat M" first="Mohsin" last="Sidat">Mohsin Sidat</name><affiliation><nlm:aff id="I5">Ministry of Health, Av. Quelimane: Av. 1 de Julho, Predio deo Monte Giro, Quelimane, Moçambique</nlm:aff><wicri:noCountry code="subfield">Moçambique</wicri:noCountry></affiliation><affiliation><nlm:aff id="I6">Faculty of Medicine, University Eduardo Mondlane, PO Box 257, Maputo, Moçambique</nlm:aff><wicri:noCountry code="subfield">Moçambique</wicri:noCountry></affiliation></author><author><name sortKey="Vergara, Alfredo" sort="Vergara, Alfredo" uniqKey="Vergara A" first="Alfredo" last="Vergara">Alfredo Vergara</name><affiliation wicri:level="2"><nlm:aff id="I2">Department of Preventive Medicine, Village at Vanderbilt, Suite 2100,1500 21st Avenue South Nashville, TN 37212, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Preventive Medicine, Village at Vanderbilt, Suite 2100,1500 21st Avenue South Nashville, TN 37212</wicri:regionArea><placeName><region type="state">Tennessee</region></placeName></affiliation><affiliation wicri:level="1"><nlm:aff id="I3">Vanderbilt Institute for Global Health, 2525 West End Ave, Suite 750, 2525 West End Ave, Nashville, TN, 37203, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Vanderbilt Institute for Global Health, 2525 West End Ave, Suite 750, 2525 West End Ave, Nashville, TN, 37203</wicri:regionArea><wicri:noRegion>37203</wicri:noRegion></affiliation></author><author><name sortKey="Vermund, Sten H" sort="Vermund, Sten H" uniqKey="Vermund S" first="Sten H" last="Vermund">Sten H. Vermund</name><affiliation wicri:level="2"><nlm:aff id="I2">Department of Preventive Medicine, Village at Vanderbilt, Suite 2100,1500 21st Avenue South Nashville, TN 37212, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Preventive Medicine, Village at Vanderbilt, Suite 2100,1500 21st Avenue South Nashville, TN 37212</wicri:regionArea><placeName><region type="state">Tennessee</region></placeName></affiliation><affiliation><nlm:aff id="I6">Faculty of Medicine, University Eduardo Mondlane, PO Box 257, Maputo, Moçambique</nlm:aff><wicri:noCountry code="subfield">Moçambique</wicri:noCountry></affiliation><affiliation><nlm:aff id="I7">Friends in Global Health, Avenida dos Trabalhadores N°424, Quelimane, Moçambique</nlm:aff><wicri:noCountry code="subfield">Moçambique</wicri:noCountry></affiliation></author><author><name sortKey="Moon, Troy D" sort="Moon, Troy D" uniqKey="Moon T" first="Troy D" last="Moon">Troy D. Moon</name><affiliation wicri:level="2"><nlm:aff id="I2">Department of Preventive Medicine, Village at Vanderbilt, Suite 2100,1500 21st Avenue South Nashville, TN 37212, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Preventive Medicine, Village at Vanderbilt, Suite 2100,1500 21st Avenue South Nashville, TN 37212</wicri:regionArea><placeName><region type="state">Tennessee</region></placeName></affiliation><affiliation><nlm:aff id="I6">Faculty of Medicine, University Eduardo Mondlane, PO Box 257, Maputo, Moçambique</nlm:aff><wicri:noCountry code="subfield">Moçambique</wicri:noCountry></affiliation><affiliation><nlm:aff id="I7">Friends in Global Health, Avenida dos Trabalhadores N°424, Quelimane, Moçambique</nlm:aff><wicri:noCountry code="subfield">Moçambique</wicri:noCountry></affiliation></author></analytic><series><title level="j">BMC Public Health</title><idno type="eISSN">1471-2458</idno><imprint><date when="2011">2011</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>HIV is treated as a chronic disease, but high lost-to-follow-up rates and poor adherence to medication result in higher mortality, morbidity, and viral mutation. Within 18 clinical sites in rural Zambézia Province, Mozambique, patient adherence to antiretroviral therapy has been sub-optimal.</p></sec><sec><title>Methods</title><p>To better understand barriers to adherence, we conducted 18 community and clinic focus groups in six rural districts. We interviewed 76 women and 88 men, of whom 124 were community participants (CP; 60 women, 64 men) and 40 were health care workers (HCW; 16 women, 24 men) who provide care for those living with HIV.</p></sec><sec><title>Results</title><p>While there was some consensus, both CP and HCW provided complementary insights. CP focus groups noted a lack of confidentiality and poor treatment by hospital staff (42% CP vs. 0% HCW), doubt as to the benefits of antiretroviral therapy (75% CP vs. 0% HCW), and sharing medications with family members (66% CP vs. 0%HCW). Men expressed a greater concern about poor treatment by HCW than women (83% men vs. 0% women). Health care workers blamed patient preference for traditional medicine (42% CP vs. 100% HCW) and the side effects of medication for poor adherence (8% CP vs. 83% CHW).</p></sec><sec><title>Conclusions</title><p>Perspectives of CP and HCW likely reflect differing sociocultural and educational backgrounds. Health care workers must understand community perspectives on causes of suboptimal adherence as a first step toward effective intervention.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Koenig, Sp" uniqKey="Koenig S">SP Koenig</name></author><author><name sortKey="Leandre, F" uniqKey="Leandre F">F Leandre</name></author><author><name sortKey="Farmer, Pe" uniqKey="Farmer P">PE Farmer</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Moon, T" uniqKey="Moon T">T Moon</name></author><author><name sortKey="Burlison, J" uniqKey="Burlison J">J Burlison</name></author><author><name sortKey="Sidat, M" uniqKey="Sidat M">M Sidat</name></author><author><name sortKey="Pires, P" uniqKey="Pires P">P Pires</name></author><author><name sortKey="Silva, W" uniqKey="Silva W">W Silva</name></author><author><name 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Herrera</name></author><author><name sortKey="Kendall, T" uniqKey="Kendall T">T Kendall</name></author><author><name sortKey="Caballero, M" uniqKey="Caballero M">M Caballero</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Banda, Y" uniqKey="Banda Y">Y Banda</name></author><author><name sortKey="Chapman, V" uniqKey="Chapman V">V Chapman</name></author><author><name sortKey="Goldenberg, Rl" uniqKey="Goldenberg R">RL Goldenberg</name></author><author><name sortKey="Stringer, Js" uniqKey="Stringer J">JS Stringer</name></author><author><name sortKey="Culhane, Jf" uniqKey="Culhane J">JF Culhane</name></author><author><name sortKey="Sinkala, M" uniqKey="Sinkala M">M Sinkala</name></author><author><name sortKey="Vermund, Sh" uniqKey="Vermund S">SH Vermund</name></author><author><name sortKey="Chi, Bh" uniqKey="Chi B">BH Chi</name></author></analytic></biblStruct></listBibl></div1></back></TEI></record>Pour manipuler ce document sous Unix (Dilib)
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