Barriers in Access and Adherence to Antiretroviral Therapy in Developing Countries
DOI:
https://doi.org/10.58445/rars.703Keywords:
human immunodeficiency virus (HIV), antiretroviral therapy (ART), morality, treatment, infectiousness, adherence, access, developing countries, healthcare, medications, epidemicAbstract
Developments in antiretroviral therapy (ART) are one of the most effective ways of treating individuals infected with HIV and lowering their level of infectiousness. This therapy has been proven to significantly lessen HIV mortality rates through its combination of medicines that aim to suppress the progression of HIV throughout the body. Taking this into account, it’s critical that patients adhere to their treatment regimen in order to obtain better outcomes and control the rate of the virus within a population. This paper includes several research studies that indicate patient adherence to antiretroviral therapy and rates of retention to be suboptimal in developing regions of Africa, India, and Latin America. Placing emphasis on the importance of treatment, this paper elaborates on the extent to which barriers, such as country access to healthcare, costs of treatment, perceived discrimination, social stigma, and religion affect patient adherence to antiretroviral therapy in resource-limited environments. Furthermore, the impact of lack and unequal access to healthcare and medications pose itself as one of the most significant obstacles promoting poor treatment adherence. Thus, this paper offers suggestions that can be taken to improve adherence among HIV-infected individuals and alleviate the barriers associated with the uptake of antiretroviral therapy, in order to collectively defeat the growing HIV/AIDS pandemic.
References
UNICEF. (2022). Global and regional trends - UNICEF DATA. UNICEF DATA. https://data.unicef.org/topic/hivaids/global-regional-trends/
WHO. (2018). HIV/AIDS. WHO | Regional Office for Africa. https://www.afro.who.int/health-topics/hivaids
Reuben, G., Somya, G., & Brian, W. (2018). 90-90-90, Epidemic Control and Ending AIDS: Global Situation and Recommendations. International Journal of Virology and AIDS, 5(1). https://doi.org/10.23937/2469-567x/1510043
UNAIDs. (2017, January 1). 90–90–90 - An ambitious treatment target to help end the AIDS epidemic. Www.unaids.org. https://www.unaids.org/en/resources/documents/2017/90-90-90
UNAIDS. (2013, February 13). Peru. Www.unaids.org. https://www.unaids.org/en/keywords/peru#:~:text=UNAIDS%20estimates%20that%20around%2074
UNAIDS. (2016b). India. Unaids.org. https://www.unaids.org/en/regionscountries/countries/india
UNAIDS. (2016c). Mozambique. Unaids.org. https://www.unaids.org/en/regionscountries/countries/mozambique
UNAIDS. (2016a). Ethiopia. Unaids.org. https://www.unaids.org/en/regionscountries/countries/ethiopia
Leyva-Moral, J. M., Loayza-Enriquez, B. K., Palmieri, P. A., Guevara-Vasquez, G. M., Elias-Bravo, U. E., Edwards, J. E., Feijoo-Cid, M., Davila-Olano, L. Y., Rodriguez-Llanos, J. R., & Leon-Jimenez, F. E. (2019). Adherence to antiretroviral therapy and the associated factors among people living with HIV/AIDS in Northern Peru: a cross-sectional study. AIDS Research and Therapy, 16(1). https://doi.org/10.1186/s12981-019-0238-y
Chakraborty, A., Hershow, R. C., Qato, D. M., Stayner, L., & Dworkin, M. S. (2020). Adherence to Antiretroviral Therapy Among HIV Patients in India: A Systematic Review and Meta-analysis. AIDS and Behavior. https://doi.org/10.1007/s10461-020-02779-4
Finci, I., Flores, A., Gutierrez Zamudio, A. G., Matsinhe, A., de Abreu, E., Issufo, S., Gaspar, I., Ciglenecki, I., & Molfino, L. (2020). Outcomes of patients on second- and third-line ART enrolled in ART adherence clubs in Maputo, Mozambique. Tropical Medicine & International Health: TM & IH, 25(12), 1496–1502. https://doi.org/10.1111/tmi.13490
Aychew Legesse, T., & Abate Reta, M. (1970). Adherence to Antiretroviral Therapy and Associated Factors among People Living with HIV/AIDS in Hara Town and Its Surroundings, North-Eastern Ethiopia: A Cross-Sectional Study. Ethiopian Journal of Health Sciences, 29(3). https://doi.org/10.4314/ejhs.v29i3.2
The Global Fund. (n.d.). About the Global Fund. Www.theglobalfund.org. https://www.theglobalfund.org/en/about-the-global-fund/#:~:text=The%20Global%20Fund%20is%20a
Castelli, F., Pietra, V., Diallo, I., Schumacher, R. F., & Simpore, J. (2010). Antiretroviral (ARV) Therapy in Resource Poor Countries: What do we Need in Real Life? The Open AIDS Journal, 4(1), 28–32. https://doi.org/10.2174/1874613601004020028
Azia, I. N., Mukumbang, F. C., & Van Wyk, B. (2016). Barriers to adherence to antiretroviral treatment in a regional hospital in Vredenburg, Western Cape, South Africa. Southern African Journal of HIV Medicine, 17(1). https://doi.org/10.4102/sajhivmed.v17i1.476
Mshana, G. H., Wamoyi, J., Busza, J., Zaba, B., Changalucha, J., Kaluvya, S., & Urassa, M. (2006). Barriers to Accessing Antiretroviral Therapy in Kisesa, Tanzania: A Qualitative Study of Early Rural Referrals to the National Program. AIDS Patient Care and STDs, 20(9), 649–657. https://doi.org/10.1089/apc.2006.20.649
Groh, K., Audet, C. M., Baptista, A., Sidat, M., Vergara, A., Vermund, S. H., & Moon, T. D. (2011). Barriers to antiretroviral therapy adherence in rural Mozambique. BMC Public Health, 11(1). https://doi.org/10.1186/1471-2458-11-650|
Ridde, V., Somé, P., & Pirkle, C. M. (2012). NGO-provided free HIV treatment and services in Burkina Faso: scarcity, therapeutic rationality and unfair process. International Journal for Equity in Health, 11(1), 11. https://doi.org/10.1186/1475-9276-11-11
Haacker, M. (2004, November 19). 10. Impact of the HIV/AIDS Epidemic on the Health Sectors of Developing Countries. Www.elibrary.imf.org; International Monetary Fund. https://www.elibrary.imf.org/display/book/9781589063600/ch10.xml?tabs=fulltext
Guy, R., Wand, H., McManus, H., Vonthanak, S., Woolley, I., Honda, M., Read, T., Sirisanthana, T., Zhou, J., & Carr, on behalf of Australia HIV Ob, A. (2013). Antiretroviral Treatment Interruption and Loss to Follow-Up in Two HIV Cohorts in Australia and Asia: Implications for “Test and Treat” Prevention Strategy. AIDS Patient Care and STDs, 27(12), 681–691. https://doi.org/10.1089/apc.2012.0439
Jewell, B. L., Smith, J. A., & Hallett, T. B. (2020). Understanding the impact of interruptions to HIV services during the COVID-19 pandemic: A modeling study. EClinicalMedicine, 26, 100483. https://doi.org/10.1016/j.eclinm.2020.100483
The World Bank. (n.d.). Literacy rate, adult total (% of people ages 15 and above) - Sub-Saharan Africa | Data. Data.worldbank.org. https://data.worldbank.org/indicator/SE.ADT.LITR.ZS?locations=ZG
Klapper, L., & Panchamia, M. V. (2023, March 13). The high price of education in Sub-Saharan Africa. Blogs.worldbank.org. https://blogs.worldbank.org/developmenttalk/high-price-education-sub-saharan-africa#:~:text=Sub%2DSaharan%20Africa%20has%20the
Hegazi, A., Bailey, R. L., Ahadzie, B., Alabi, A., & Peterson, K. (2010). Literacy, education and adherence to antiretroviral therapy in The Gambia. AIDS Care, 22(11), 1340–1345. https://doi.org/10.1080/09540121003693514
Angelo, A. T., & Alemayehu, D. S. (2021). Adherence and Its Associated Factors Among Adult HIV-Infected Patients on Antiretroviral Therapy in South Western Ethiopia, 2020. Patient Preference and Adherence, Volume 15, 299–308. https://doi.org/10.2147/ppa.s298594
Anderson, B. J. (2020). HIV Stigma and Discrimination Persist, Even in Health Care. AMA Journal of Ethics, 11(12), 998–1001. https://doi.org/10.1001/virtualmentor.2009.11.12.oped1-0912.
Katz, I. T., Ryu, A. E., Onuegbu, A. G., Psaros, C., Weiser, S. D., Bangsberg, D. R., & Tsai, A. C. (2013). Impact of HIV-related stigma on treatment adherence: systematic review and meta-synthesis. Journal of the International AIDS Society, 16(3), 18640. https://doi.org/10.7448/ias.16.3.18640
Zou, J., Yamanaka, Y., John, M., Watt, M., Ostermann, J., & Thielman, N. (2009). Religion and HIV in Tanzania: influence of religious beliefs on HIV stigma, disclosure, and treatment attitudes. BMC Public Health, 9(1). https://doi.org/10.1186/1471-2458-9-75
Azia, I., Mukumbang, F. C., Shernaaz, C., & Nyembezi, A. (2022). Role of religious beliefs on antiretroviral treatment adherence among Pentecostal Christians in sub-Saharan Africa: a scoping review protocol. BMJ Open, 12(4), e052750. https://doi.org/10.1136/bmjopen-2021-052750
Zhou, G., Li, X., Qiao, S., Shen, Z., & Zhou, Y. (2018). Influence of Side Effects on ART Adherence Among PLWH in China: The Moderator Role of ART-Related Knowledge. AIDS and Behavior, 22(3), 961–970. https://doi.org/10.1007/s10461-017-1791-9
Bukenya, D., Mayanja, B. N., Nakamanya, S., Muhumuza, R., & Seeley, J. (2019). What causes non-adherence among some individuals on long term antiretroviral therapy? Experiences of individuals with poor viral suppression in Uganda. AIDS Research and Therapy, 16(1). https://doi.org/10.1186/s12981-018-0214-y
Simoni, J. M., Aunon, F. M., Kemp, C. J., Kutner, B. A., Ramaiya, M. K., Velloza, J., & Yang, J. P. (2017). Implementation research on HIV adherence interventions: No time to wait. The next Generation of Research on HIV Adherence Interventions: No Time to Wait, 17(6), 564–565. https://doi.org/10.1016/s1473-3099(17)30106-8
Tseng, A., Seet, J., & Phillips, E. J. (2015). The evolution of three decades of antiretroviral therapy: challenges, triumphs and the promise of the future. British Journal of Clinical Pharmacology, 79(2), 182–194. https://doi.org/10.1111/bcp.12403
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