Date Published: February 22, 2012
Publisher: Hindawi Publishing Corporation
Author(s): Ayalu A. Reda, Sibhatu Biadgilign.
Background. There are only a few comprehensive studies of adherence to ART and its challenges in Africa. This paper aims to assess the evidence on the challenges and prospects of ART adherence in sub-Saharan Africa. Methods. The authors reviewed original and review articles involving HIV-positive individuals that measured adherence to ART and its predictors in the past decade. Findings. Against expectations, sub-Saharan Africa patients have similar or higher adherence levels compared to those of developed countries. The challenges to ART adherence include factors related to patients and their families, socioeconomic factors, medication, and healthcare systems. Conclusion. Despite good adherence and program-related findings, antiretroviral treatment is challenged by a range of hierarchical and interrelated factors. There is substantial room for improvement of ART programs in sub-Sahara African countries.
Acquired immune deficiency syndrome (AIDS) is one of the most destructive epidemics the world has ever witnessed. Presently an estimated 33.4 million people are living with HIV worldwide, nearly two-thirds of these live in sub-Saharan Africa .
African HIV/AIDS patients have similar or higher adherence levels compared to those of developed countries. The challenges of adherence to ART identified include factors related to patients and their families, socioeconomic factors, medication, and healthcare systems as summarized in Figure 1. This has implications for interventions to improve ART adherence and therefore the program needs to address these interrelated and multidimensional factors [78, 79]. In other words, ensuring adherence to treatment and retention requires an understanding of the multiple barriers that patients face and developing interventions that overcome these barriers. Long-term maintenance of adherence requires the integration of these interventions into sustainable programs that ensure a reliable supply of drugs, patient education, and ongoing support .
There is a relatively modest level of adherence to antiretroviral treatment among HIV/AIDS patients in sub-Saharan Africa. However, it is challenged by a range of hierarchical and intricately related factors and there is substantial room for improvement of the ART programs in the region. Vulnerable groups such as children and adolescents need special attention by health workers and policy makers. There is also a need for adherence indicators and interventions that are applicable in the setting of developing countries.