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Monday 24th October 2016

Africans stop HIV treatments

16th October 2007

More than a third of people receiving antiretroviral therapy (ART) on HIV treatment programmes in African countries stop taking the medication within two years of being enrolled, new research has shown.


Half of those do so because they die, while the other half discontinued treatment within two years because of high cost, travelling distance to the clinic, or fear of the social stigma attached to being an HIV patient, the study, published in the online journal PLoS Medicine, said.

A team of researchers at the University of the Witwatersrand Health Consortium in Johannesburg, South Africa, studied retention rates of adult patients in ART programmes in 13 sub-Saharan African countries, by reviewing 32 reports published between 2000 and 2007.

They found a wide variation in the rates of patient retention after two years. The average retention rate after two years was 61.6%, while the best programmes managed a rate of 85%. The worst programmes in the study only managed to retain 46% of patients after two years, they said.

Many patients died on the programmes because they began treatment too late to control the HIV virus, and earlier initiation of ART was crucial to reduce HIV death rates, the study said.

It suggested better patient-tracing procedures, and a better understanding of the phenomenon known as "loss to follow-up".

Some programmes already ask for full contact details from patients, and use cultural and social events like music and dance performances to spread the word about ART programmes, including the concept of a life-long commitment to taking the drugs.

Mary-Louise Newell, director of the Africa Centre for Health and Population Studies in South Africa's KwaZulu Natal province, said her centre, which serves a rural, mostly Zulu population, had found that follow-up from caregivers was crucial for an ART programme to work effectively. It now reported very low levels of loss to follow-up, she said.

Africa Centre research physician Graham Cooke said that average travel distances for the centre's patients had now been reduced to less than three kilometres, from 37 kilometres initially. This had been done by establishing smaller, local clinics to serve communities, he said.

One positive side-effect of the improvement in HIV patient's health was that their friends, family or neighbours would also then present themselves for treatment, Cooke said, although mortality remained unacceptably high.

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