Abstract
BackgroundVery little is known about the barriers and facilitators to antiretroviral therapy (ART) access and adherence among older Africans. Most studies on ART have focused on individuals who are 15–49 years of age.MethodsWe used in-depth interviews with 40 persons living with HIV, aged 50 to 96 years, who had either initiated ART (n = 26) or were waiting to initiate ART (n = 14), to explore barriers and facilitators to ART access and adherence in rural Uganda.ResultsGuided by the Andersen Behavior Model, thematic content analysis highlighted 21 primary factors related to environment, patient and health behavior. Nine of the factors were common to both access and adherence, the remaining 12 were evenly split between access and adherence. Transportation costs, food insecurity, and healthcare workers’ knowledge, attitudes and behaviors were key barriers.ConclusionsThese barriers were similar to those outlined for younger populations in other studies, but were compounded by age. Despite barriers, either due to the exceptional nature of HIV care or overreporting, both ART access and self-reported adherence were better than expected. Older persons living with HIV highlighted health care needs for non-HIV-related illnesses, suggesting while HIV care is adequate, care for the ailments of “old age” is lagging.
Highlights
Very little is known about the barriers and facilitators to antiretroviral therapy (ART) access and adherence among older Africans
ART has led to a greater number of people living with, and aging with the infection, creating a growing proportion of people over 50 years old living with HIV [4, 5]
HIV infection has long been viewed as a condition of young people, for this reason most policies, programs and data collection have focused on people aged 15–49 years [6, 7]
Summary
Very little is known about the barriers and facilitators to antiretroviral therapy (ART) access and adherence among older Africans. HIV infection has long been viewed as a condition of young people, for this reason most policies, programs and data collection have focused on people aged 15–49 years [6, 7]. The HIV treatment cascade, or care continuum, focuses on a number of steps from diagnosis to viral suppression. These steps include access to HIV testing; linkages to care; engaging in care; and achieving viral suppression. The United Nations (UN) has set a 90– 90-90 target to have 90% of those individuals infected with HIV diagnosed, 90% of those living with HIV on ART, and 90% virally suppressed by 2020 [12, 13]. The fact that there are few data on HIV testing, treatment and adherence among older people in SSA
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