Are Expert Patients an Untapped Resource for ART Provision in Sub-Saharan Africa?

Tom Decroo,Freya Rasschaert,Guy Kegels,Daniel Remartinez,Wim Van Damme

doi:10.1155/2012/749718

Tom Decroo, Freya Rasschaert + Show 3 more

Open Access

https://doi.org/10.1155/2012/749718

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Abstract

Since the introduction of antiretroviral treatment, HIV/AIDS can be framed as a chronic lifelong condition, requiring lifelong adherence to medication. Reinforcement of self-management through information, acquisition of problem solving skills, motivation, and peer support is expected to allow PLWHA to become involved as expert patients in the care management and to decrease the dependency on scarce skilled medical staff. We developed a conceptual framework to analyse how PLWHA can become expert patients and performed a literature review on involvement of PLWHA as expert patients in ART provision in Sub-Saharan Africa. This paper revealed two published examples: one on trained PLWHA in Kenya and another on self-formed peer groups in Mozambique. Both programs fit the concept of the expert patient and describe how community-embedded ART programs can be effective and improve the accessibility and affordability of ART. Using their day-to-day experience of living with HIV, expert patients are able to provide better fitting solutions to practical and psychosocial barriers to adherence. There is a need for careful design of models in which expert patients are involved in essential care functions, capacitated, and empowered to manage their condition and support fellow peers, as an untapped resource to control HIV/AIDS.

Highlights

By the end of 2010, approximately 5,1 million people were receiving antiretroviral therapy (ART) in sub-Saharan Africa (SSA) representing only 49% of people in need of treatment [1]
In order to structure our thinking about the involvement of PLWHA as expert patients, we developed a framework to illustrate the different elements required to reinforce HIV self-management and to empower PLWHA to become engaged in the care for their condition as expert patients (Figure 1)
Of the 26 remaining articles, 6 were excluded as they described a nurse-based care model without an explicit involvement of PLWHA. Another 9 articles were excluded as lay providers were involved in psychosocial support and adherence support, but not in ART provision, and PLWHA were not involved or PLWHA involvement was not explicitly described

Summary

Introduction

By the end of 2010, approximately 5,1 million people were receiving antiretroviral therapy (ART) in sub-Saharan Africa (SSA) representing only 49% of people in need of treatment [1]. For those fortunate enough to access ART, HIV infection became a chronic disease requiring lifelong treatment. In 2010, a systematic review reported 80.2% (CI 78.0–82.4%), 76.1% (CI 72.4–79.7%), and 72.3% (67.4–76.9%) retention in ART at 12, 24, and 36 months of treatment, respectively, [2]. Long distances to health facilities, scarce availability and high cost of transport limit access [3, 4]

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