Access to and impact of HAART

Anti-retroviral therapy (ART) is one of the interventions currently in place to prolong the progression from HIV to AIDS for PLHIV. However, since the introduction of ART in Ghana in 2003, there has been scanty research on the preferences of PLHIV in accessing ART services. The main objective of the study therefore was to examine the preferences of PLHIV on ART services in terms of media, facility, service provider, time and cost of services. Through the purposive sampling procedure, a total of 145 FGDs and 171 IDIs were conducted among PLHIV, migrant workers, female sex workers, men having sex with men in 12 cities/towns selected from the three ecological zones of Ghana. The results show that the most preferred place for treatment was facility-based because it reduces stigmatization. Females were more sensitive to stigmatization than males and thus preferred a ‘foreigner’ to attend to them while males were indifferent. The radio and television were the most preferred media for education on ART but the information should be given by trained PLHIV as resource persons. ART services should be provided free of charge. Knowledge on the preferences of PLHIV on ART could inform policies and programmes on ART service delivery in the country.

Background: Failure to adhere to ART therapy led to increase in clients’ morbidity, mortality and development of drug resistance leading to unsuccessful outcome. There was lack of systematic and coordinated process of tracking clients.
Method: CT system was introduced, developed and implemented in 2007 to reduce loss to follow-up and increase client retention in care. Contact Tracking Team (CTT) were trained and supported via mentoring on the use of standardized CT tools and ART register update.
The CTT began tracking defaulters monthly and later a day after a client misses a refill appointment. Clients who miss refill appointment are captured as defaulters and are tracked immediately.
Referral network was established through and they are mentored on linkages/referral services and on defaulter tracking.
RESULTS: Three years after, the number of clients lost to follow-up reduced from 370 in 2006 to 45 in 2010. 222 clients who were once lost to follow-up have been re-started on ARV. The formation of CTT improved working relationship between staff and successful CT outcomes.
Conclusion: Effective CT can increase the number of HIV clients retained in care and reduce loss to follow-up. Use of standardized CT tools enhances systematic documentation of clients for improved treatment outcomes.

Against the background of high HIV infection rates and AIDS-related death in the 1990s, the government of Botswana declared HIV and AIDS a national emergency and committed an aggressive and comprehensive multi-sectoral and multi-level response to fight the epidemic and mitigate its socio-economic impact. One venue of the response has been the provision of free HAART to all eligible citizens through the National ARV Therapy Programme. Introduced in 2002, the programme is now available countrywide, with over 90% of people in need of it accessing it free of charge. This success has, however, been accompanied by many anecdotal accounts of an increase in the prevalence of risky sexual behaviour. Using a combination of quantitative and qualitative data, this paper assesses the perceived association between the availability of HAART and high-risk sexual behaviour in the country. The results show suggest that contrary to the anecdotal accounts people continue practising, and even adopting, safe sex and health-seeking behaviours such as consistent condom use, having one sexual partner, and uptake of voluntary HIV testing. Among other things, the study concludes that increased contact with health systems to receive HAART may actually encourage positive changes in risky sexual behaviours.

Objective. This study is aimed at analysing the trend of mention to non-HIV related causes of death in the death certificates of adults who lived with HIV/AIDS in Brazil.
Methods: Data of the deaths occurred in Brazilian adults between 1999 and 2010 were analysed. Standardized mortality odds ratios were used to compare causes of death in individuals who had HIV/AIDS listed on any field of the death certificate with those who deaths who had no mention to this disease.
Results. From 1999 to 2010, 6120670 deaths occurred in adults in Brazil and 2.2% of those had HIV/AIDS mentioned in the death certificate. Causes non-associated with HIV/AIDS, more specifically, cardiovascular diseases, genitourinary diseases and malign presented a steady and significantly larger increase in the frequency with which they were listed as causes of death for individuals who also had HIV listed on the death certificate.
Conclusion. The results suggest that the long cohabition with HIV and HAART might have an important role in the development of non-associated HIV/AIDS diseases in people living with HIV/AIDS.
Key-words: AIDS, HIV, mortality, causes of death, death certificate.