Bridging the Gap Between Antiretroviral Access and Adherence in Mexico

Abstract

The goal in this article is to examine social problems associated with highly active antiretroviral therapy (HAART) adherence in Mexico and the related challenges for Mexican persons living with HIV/AIDS (PLWHAs). The study was conducted from the perspective of infected and affected individuals. The authors completed 64 in-depth interviews with heterosexual male and female PLWHAs, as well as with some key individuals from their social network. Following the principles of grounded theory, they carried out inductive analysis to create codes and organize central themes. The authors identified problems related to accessing HAART and found that conditions for implementing recommendations made in the international literature to improve adherence are poor. The findings highlight the importance of social factors, such as health care system irregularities, ineffective physician-patient communication, and availability of family and other sources of social support such as self-help groups for PLWHAs' access and adherence to antiretroviral therapy in Mexico.

Obstacles and Proposed Solutions to Effective Antiretroviral Therapy in Resource-Limited Settings

“…Thirty relevant studies were identified, of which 11 were in peerreviewed journals [15][16][17][18][19][20][21][22][23][24][25] and 19 were in conference abstracts. [26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44] The earliest studies included in this review were from 2004, reflecting a greater emphasis on research in this field after major initiatives were undertaken (such as ''3 by 5'' by the WHO and the President's Emergency Plan for AIDS Relief [PEPFAR]) to increase ART access in resource-limited countries.…”

“…Among the 30 studies, 21 were from Africa,* 6 from east/southeast Asia,The data collection methods described in the papers comprised mostly of interviews (22 studies), y surveys (7 studies), 16,27,29,34,39,40,42 review of clinical data (7 studies), 18,20,22,27,31,36,38 and focus-group discussions (6 studies). 21,23,28,32,42,43 Respondents included PLWHA with/without ART (22 studies), z noninfected people including elders, teenagers, and university students (11 studies), § health care workers including nurses, doctors, social workers, laboratory technologists (7 studies), 15,21,25,28,30,42,43 family members and/or friends of PLWHA (5 studies), 17,19,21,25,43 traditional healers (1 study), 21 and representatives of nongovernmental and community-based organizations (NGOs and CBOs; 1 study).…”

“…16,30 Although free or discounted ART was available, some respondents claimed difficulty in affording the costs of laboratory testing, which is a prerequisite for the treatment. 17,31,41 Some studies reported an insufficient number of laboratories and poor quality equipment. 30 These factors may delay testing and obtaining results, which further prevented the timely initiation of ART.…”

“…24 19 (even though ART is available for free, patients cannot afford the cost of laboratory testing which might be prerequisite for free ART). 17,31,41 3. Loss of wages due to routine clinic visits.…”

“…Paucity of laboratory facilities for ART 33 and HIV/AIDS disease monitoring, thus prompting long distances travelled 24 and greater delay in obtaining results. 17,30 4. Lack of consistent supply of drugs and other laboratory materials.…”