Abstract
ABSTRACT Adherence to antiretroviral therapy (ART) is critical in order to achieve viral suppression. We designed an intervention, Mobile Antiretroviral Therapy and HIV care (MAP-HC) in rural southwestern Uganda aimed to reduce travel distance and hypothesized that MAP-HC would improve ART adherence and rates of viral load suppression. The study was conducted at two district hospitals, among patients who lived >5 km from the hospital. For each hospital, we identified 4 health centers in the catchment area to serve as site for the mobile pharmacy. Each site was visited once a month to provide ART refills and adherence counseling. We measured patient waiting time, adherence and viral load suppression before and after the intervention. The proportion of patients who missed an ART dose in the last 30 days dropped from 20% to 8.5% at 12 months post-intervention (p = 0.009) and those with detectable viral load dropped from 19.9% to 7.4% (p = 0.001), however, mean waiting time increased from 4.48 to 4.76 h (p = 0.13). Mobile pharmacy intervention in rural Uganda is feasible and resulted in improvement in adherence and viral load suppression. Although it did not reduce patient waiting time at the clinic, we recommend scale-up in rural areas where patients face transportation challenges.
Highlights
Adherence to antiretroviral therapy (ART) is critical in order to achieve viral suppression, one of three UNAIDS targets set for achievement before 2020
Several studies have examined geographical factors as barriers and systematic analysis has shown that travel distance is a barrier across the continuum of HIV care from testing to treatment and retention in care [9]
We reviewed the appointment dates for all patients that consented to participate in Mobile Antiretroviral Therapy and HIV care (MAP-HC) and synchronized appointment and ART refill dates by zone
Summary
Adherence to antiretroviral therapy (ART) is critical in order to achieve viral suppression, one of three UNAIDS targets set for achievement before 2020. One of the main barriers to adherence is the long distance between patient residences and healthcare facilities. Several studies have examined geographical factors as barriers and systematic analysis has shown that travel distance is a barrier across the continuum of HIV care from testing to treatment and retention in care [9]. Patients narrate how they struggle to raise the monthly transportation fee to the clinics to collect their medicines [10, 11]. Long waiting times because clinics are crowded [12] cause patients to view their monthly visits as burdensome, competing with time needed to tend to gardens and other income generating activities
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