Barriers to Accessing Highly Active Antiretroviral Therapy by HIV-positive Women Attending an Antenatal Clinic in a Regional Hospital in Western Uganda

Overview

Journal J Int AIDS Soc

Specialty Infectious Diseases

Date 2010 Sep 25

PMID 20863399

Citations 132

Authors

Putu Duff

Walter Kipp

T Cameron Wild

Tom Rubaale

Joa Okech-Ojony

Affiliations

Soon will be listed here.

Abstract

Background: The aim of this study was to describe barriers to accessing and accepting highly active antiretroviral therapy (HAART) by HIV-positive mothers in the Ugandan Kabarole District's Programme for the Prevention of Mother to Child Transmission-Plus (PMTCT-Plus).

Methods: Our study was a qualitative descriptive exploratory study using thematic analysis. Individual in-depth interviews (n = 45) were conducted with randomly selected HIV-positive mothers who attended this programme, and who: (a) never enrolled in HAART (n = 17); (b) enrolled but did not come back to receive HAART (n = 2); (c) defaulted/interrupted HAART (n = 14); and (d) are currently adhering to HAART (n = 12). A focus group was also conducted to verify the results from the interviews.

Results: Results indicated that economic concerns, particularly transport costs from residences to the clinics, represented the greatest barrier to accessing treatment. In addition, HIV-related stigma and non-disclosure of HIV status to clients' sexual partners, long waiting times at the clinic and suboptimal provider-patient interactions at the hospital emerged as significant barriers.

Conclusions: These barriers to antiretroviral treatment of pregnant and post-natal women need to be addressed in order to improve HAART uptake and adherence for this group of the population. This would improve their survival and, at the same time, drastically reduce HIV transmission from mother to child.

Citing Articles

Barriers facilitators and needs of female sex workers in Arak to access sexual health services a qualitative study.

Navidi I, Shakibazadeh E, Raisi F, Akbarpour S Sci Rep. 2025; 15(1):2424.

PMID: 39827244 PMC: 11742978. DOI: 10.1038/s41598-024-84206-5.

Post-intervention perceptions on the antiretroviral therapy community group model in Trans Nzoia County, Kenya.

Naanyu V, Koros H, Goodrich S, Siika A, Toroitich-Ruto C, Bateganya M Pan Afr Med J. 2024; 47:113.

PMID: 38828427 PMC: 11143075. DOI: 10.11604/pamj.2024.47.113.41843.

Barriers to Accessing Antiretroviral Treatment Among Key Populations in Southwest Nigeria.

Okonkwo P, Olatoregun O, Abolarin O, Olajide O Cureus. 2024; 16(4):e59312.

PMID: 38817528 PMC: 11137604. DOI: 10.7759/cureus.59312.

Experiences of people living with HIV in low- and middle-income countries and their perspectives in self-management: a meta-synthesis.

Dadi T, Wiemers A, Tegene Y, Medhin G, Spigt M AIDS Res Ther. 2024; 21(1):7.

PMID: 38297363 PMC: 10829476. DOI: 10.1186/s12981-024-00595-7.

Dynamic evolution and spatial difference of public health service supply in economically developed provinces of China: typical evidence from Guangdong Province.

He Y, Zhang Y, Wu R, Huang W, Wang R, He L BMC Health Serv Res. 2024; 24(1):23.

PMID: 38178099 PMC: 10768127. DOI: 10.1186/s12913-023-10444-4.

References

Maman S, Mbwambo J, Hogan N, Kilonzo G, Sweat M . Women's barriers to HIV-1 testing and disclosure: challenges for HIV-1 voluntary counselling and testing. AIDS Care. 2001; 13(5):595-603. DOI: 10.1080/09540120120063223. View

Kitahata M, Gange S, Abraham A, Merriman B, Saag M, Justice A . Effect of early versus deferred antiretroviral therapy for HIV on survival. N Engl J Med. 2009; 360(18):1815-26. PMC: 2854555. DOI: 10.1056/NEJMoa0807252. View

Mshana G, Wamoyi J, Busza J, Zaba B, Changalucha J, Kaluvya S . Barriers to accessing antiretroviral therapy in Kisesa, Tanzania: a qualitative study of early rural referrals to the national program. AIDS Patient Care STDS. 2006; 20(9):649-57. DOI: 10.1089/apc.2006.20.649. View

Mbonye A, Hansen K, Wamono F, Magnussen P . Increasing access to prevention of mother-to-child transmission of HIV services through the private sector in Uganda. Sex Transm Infect. 2009; 85(7):534-9. DOI: 10.1136/sti.2009.037986. View

Jaffar S, Amuron B, Foster S, Birungi J, Levin J, Namara G . Rates of virological failure in patients treated in a home-based versus a facility-based HIV-care model in Jinja, southeast Uganda: a cluster-randomised equivalence trial. Lancet. 2009; 374(9707):2080-2089. PMC: 2806484. DOI: 10.1016/S0140-6736(09)61674-3. View

Nachega J, Lehman D, Hlatshwayo D, Mothopeng R, Chaisson R, Karstaedt A . HIV/AIDS and antiretroviral treatment knowledge, attitudes, beliefs, and practices in HIV-infected adults in Soweto, South Africa. J Acquir Immune Defic Syndr. 2005; 38(2):196-201. DOI: 10.1097/00126334-200502010-00011. View

Medley A, Garcia-Moreno C, McGill S, Maman S . Rates, barriers and outcomes of HIV serostatus disclosure among women in developing countries: implications for prevention of mother-to-child transmission programmes. Bull World Health Organ. 2004; 82(4):299-307. PMC: 2585956. View

Hladik W, Musinguzi J, Kirungi W, Opio A, Stover J, Kaharuza F . The estimated burden of HIV/AIDS in Uganda, 2005-2010. AIDS. 2008; 22(4):503-10. DOI: 10.1097/QAD.0b013e3282f470be. View

Orrell C . Antiretroviral adherence in a resource-poor setting. Curr HIV/AIDS Rep. 2005; 2(4):171-6. DOI: 10.1007/s11904-005-0012-8. View

10.

Mbonye A, Hansen K, Wamono F, Magnussen P . Barriers to prevention of mother-to-child transmission of HIV services in Uganda. J Biosoc Sci. 2009; 42(2):271-83. DOI: 10.1017/S002193200999040X. View

11.

Olley B, Seedat S, Stein D . Self-disclosure of HIV serostatus in recently diagnosed patients with HIV in South Africa. Afr J Reprod Health. 2004; 8(2):71-6. View

12.

Murray L, Semrau K, McCurley E, Thea D, Scott N, Mwiya M . Barriers to acceptance and adherence of antiretroviral therapy in urban Zambian women: a qualitative study. AIDS Care. 2008; 21(1):78-86. PMC: 2821879. DOI: 10.1080/09540120802032643. View

13.

Gerbert B, Maguire B, Bleecker T, Coates T, McPhee S . Primary care physicians and AIDS. Attitudinal and structural barriers to care. JAMA. 1991; 266(20):2837-42. View

14.

Hongoro C, McPake B . Human resources in health: putting the right agenda back to the front. Trop Med Int Health. 2003; 8(11):965-6. DOI: 10.1046/j.1360-2276.2003.01118.x. View

15.

Makombe S, Libamba E, Mhango E, de Ascurra Teck O, Aberle-Grasse J, Hochgesang M . Who is accessing antiretroviral therapy during national scale-up in Malawi?. Trans R Soc Trop Med Hyg. 2006; 100(10):975-9. DOI: 10.1016/j.trstmh.2005.11.007. View

16.

Tuller D, Bangsberg D, Senkungu J, Ware N, Emenyonu N, Weiser S . Transportation costs impede sustained adherence and access to HAART in a clinic population in southwestern Uganda: a qualitative study. AIDS Behav. 2009; 14(4):778-84. PMC: 2888948. DOI: 10.1007/s10461-009-9533-2. View

17.

Braitstein P, Boulle A, Nash D, Brinkhof M, Dabis F, Laurent C . Gender and the use of antiretroviral treatment in resource-constrained settings: findings from a multicenter collaboration. J Womens Health (Larchmt). 2008; 17(1):47-55. DOI: 10.1089/jwh.2007.0353. View

18.

Grant E, Logie D, Masura M, Gorman D, Murray S . Factors facilitating and challenging access and adherence to antiretroviral therapy in a township in the Zambian Copperbelt: a qualitative study. AIDS Care. 2008; 20(10):1155-60. DOI: 10.1080/09540120701854634. View

19.

Weidle P, Malamba S, Mwebaze R, Sozi C, Rukundo G, Downing R . Assessment of a pilot antiretroviral drug therapy programme in Uganda: patients' response, survival, and drug resistance. Lancet. 2002; 360(9326):34-40. DOI: 10.1016/S0140-6736(02)09330-3. View

20.

Chang L, Alamo S, Guma S, Christopher J, Suntoke T, Omasete R . Two-year virologic outcomes of an alternative AIDS care model: evaluation of a peer health worker and nurse-staffed community-based program in Uganda. J Acquir Immune Defic Syndr. 2009; 50(3):276-82. PMC: 2662625. DOI: 10.1097/QAI.0b013e3181988375. View