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Antiretroviral therapy is increasingly available in African communities. We set out to gain patient perceptions on factors which facilitate and challenge access and adherence to such therapy. We carried out two semi-structured interviews 12 months apart with 40 HIV positive people drawn from three economically deprived townships in the Copperbelt, Zambia. We also conducted a focus group of 12 of these interviewees. Availability of medication in health facilities did not automatically ensure access to those in need. A prerequisite for commencing on treatment was a positive documented HIV test result, but too few HIV testing centres, fear of family and community rejection, and male domination in sexual and social decision-making prevented a number from coming forward to be tested. Once within the system of care further barriers such as rumours of bad side-effects, inconsistent information, high costs of drugs (at the time of the first interviews), ongoing costs of additional medical tests, overcrowded systems and overworked staff all hindered access to receiving treatment. When taken, therapy brought side effects, the most common being increased appetite and hunger. Yet, despite these barriers and challenges many of those on treatment reported good adherence. Immediate factors such as seeing ill people becoming well; being supported by a friend or family member; and having a watch or clock to keep to a regular regime were important. The increase in the number of people who were expected to die, but were now looking well also shifted community attitudes. HIV/AIDS is beginning to move from a hidden terminal disease, to a chronic condition which is treatable. largest town in Zambia. After three decades of decline, copper and gold mining is seeing resurgence but unemployment is high and poverty widespread. Subsistence farming, a necessity to supplement income or as its main source, has declined as increasing numbers of workers have become too ill to manage even the modest labour involved. MethodsWe recruited a broad range of people attending the Isubilo Community Resource Programme, which provides care and support in a community setting for those infected with HIV/AIDS in three crowded townships in Ndola. A qualitative longitudinal approach was chosen to best capture in-depth perspectives of the participants over time and in a flexible and sensitive manner (Mays & Pope, 1996).In March 2005, a local support worker (MM) who was herself HIV +ve, conducted semi-structured interviews with 40 HIV+ve patients who volunteered to participate after information on the study was disseminated. Participants were recruited to gain a representative sample of those attending the clinics. The majority of those invited for interview took part: those who declined gave as reasons, sickness and fatigue. We developed and piloted an interview guide focussing on the illness experience, being tested, antiretroviral treatment access, and adherence. Following written consent, interviews were conducted in the local language, Bemba, and re...

Background: Despite growing HIV and cancer prevalence in Sub-Saharan Africa, and WHO advocacy for a public health approach to palliative care provision, opioid availability is severely limited. Uganda has achieved a morphine roll-out programme in partnership with the Ministry of Health. This study aimed to evaluate that programme by identifying challenges to implementation that may inform replication.

For palliative care to thrive in any resource-poor country it must be integrated into the public health system and secure long-term funding.

<strong>How to cite this article:</strong>Logie DE, Rowson M,Mugisha NM, McPake B. Affordable primary health care in low-income countries: Can it be achieved? Afr J Prm Health Care Fam Med. 2010;2(1),Art. #246, 3 pages. DOI:10.4102/phcfm.v2i1.24

40 Hausen B, Heublein B, Vogelphol J, Von der Leyen H, Haverich A.Comparison of enoximone and piroximone in patients after mitral valve operation: a prospective and controlled study.

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BRITISH was detected. Further aspirations produced no benefit, but an increased dose of steroids helped. However, two weeks later she developed severe respiratory failure and died. At necropsy the lungs showed prominent arterial radicles, a moderate amount of oedema, and scattered, mainly subpleural, areas suggestive of chronic pneumonitis. Both latter features were worse on the left (weight 985g.) than on the right (weight 720g.) Both pleural spaces contained old fibrous adhesions and bilateral yellow effusions. The heart (weight 360g.) showed right ventricular hypertrophy (10mmn.) and dilatation; the right auricle was normal. There was no thrombosis in the syst-mic vessels. The lungs were sent to Professor Herbert Spencer for examination. rn his opinion they showed: (1) Some pulmonary arterial thickening; occasional arteries also showed recanalization; (2) interstitial fibrosis (Fig.) plus recent intra-alveolar fibrinous oedema; (3) pronounced dilatation of the bronchial veins; (4) enormous distension of the alveolar capillaries in places; and (5) thrombosis of smalland medium-sized veins with evidence of recanalization. These changes add up to thrombosis of the pulmonary venous return with subsequent oedema, collateral channel formation, and pulmonary artery hypertension (with occasional arterial thrombosis and recanalization). The disease was an evolving condition in this patient as is apparent from the varying degrees of oedema and venous occlusion. Despite this activity no aetiological agent was discovered. Perhaps virus culture of the sputum would have been revealing, since Liebow suggests haemagglutination associated with pulmonary viral infections is possibly the cause of the thrombosis. More information could have been forthcoming had the patient been diagnosed in life. The object of this report is to remind clinicians and pathologists of the disease, and to underline the opinion of previous authors that it may not be as rare as the literature suggests.-We are, etc.,