Summaryobjective To present a review of barriers impeding people living with HIV ⁄ AIDS in developing countries from accessing treatment, and to make recommendations for further studies.methods Electronic databases, websites of main global agencies and international AIDS conferences were searched for relevant articles published between 1996 and 2007. Articles were reviewed using the Andersen and May framework of access to health services and barriers were categorized as either population-level or health system-level barriers.results A total of 19 studies (7 articles and 12 abstracts) in English were reviewed. The barriers most frequently cited at the population level were lack of information about antiretroviral therapy (ART), perceived high costs for ART and stigma. Barriers most frequently cited at the health system level were long distance from home to the health facility, lack of co-ordination across services and limited involvement of the community in the programme planning process.conclusions Dissemination of information about HIV ⁄ AIDS and alternative related care, and alternative health financing policies seem to be the most relevant policy measures to remove barriers. In view of the paucity of evidence on barriers to access to ART, research should address the relative importance of barriers, include a mix of qualitative and quantitative research methods and evaluate barriers in different settings.
This study identifies, ranks, and compares factors perceived as barriers to accessing antiretroviral treatment (ART) in urban and rural settings in Mozambique. Data were collected between March and July 2008. It consisted of 13 focus group discussions and a structured questionnaire administered to 252 people living with HIV/AIDS (PLWHA) and 28 health workers in the districts of Beira and Buzi. Data analysis was performed using content analysis, factor analysis, and percentages of the maximum attainable scores. The data analysis revealed six clusters of factors, which were ranked according to the percentages of the maximum attainable scores between brackets: (1) patient resource availability, in which distance from home to the health facility, transportation and food availability were rated below 40%; (2) community information (47%), and (3) service availability (53%), in which the waiting time to receive the results of CD4 analysis and the sufficiency of doctors/nurses at the health facility were both rated at 45%; (4) patient information and attitudes toward treatment (74%); family support (77%) and health personnel confidentiality (79%). Policy makers, in efforts to further improve the access to ART may decide to target their attention in designing interventions to improve specific aspects of patient resource availability, community information, and service availability in both urban and rural settings.
Background: The availability of Antiretroviral Treatment (ART) has changed the course of HIV/AIDS, by transforming it into a chronic condition. However, important challenges remain in the management of HIV/AIDS. These challenges are exacerbated by the fact that in resource limited settings, food insecurity and HIV/AIDS overlap. The aim of our study was to evaluate the effect of a food assistance program on adherence to ART in Sofala province, Mozambique. Methods: In order to assess the effect of the food assistance program on adherence we used propensity score matching with difference in differences estimation. We compared food assistance recipients with controls. We measured adherence based on pill pickup , a pharmacy adherence measure. Results: During the food assistance programme, the adherence of food assistance recipients who received food assistance for a period of six and 12 months and non-food assistance recipients is not significantly different as the average impact is only 0.4% (p=0.94) and-2.3% (p=0.73) respectively. For the period after food assistance had been terminated, adherence is still not significantly different between the two groups, as the average impact is 5.3% (p=0.44) and 1.9% (p=0.65). Conclusion: Our study suggests that food assistance provided to HIV/AIDS patients in Sofala province in Mozambique had no effect on their adherence to ART. Our results indicate that although efforts have been put forth to reduce food insecurity among HIV/AIDS patients, more should be done to ensure that these efforts really result in the improvement of adherence to ART. J o ur nal o f A ID S & Cli n ic a l R es earc h
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