Master of Science
Global Health Systems in Africa
With the rapid expansion of HIV treatment programs across sub-Saharan Africa, substantial progress has been made towards universal treatment accessibility in Uganda; however, new healthcare challenges have been emerging, such as the development of drug-resistant HIV, which threaten to undermine achievements made thus far. In order for HIV treatment to be effective, people living with HIV (PLWH) must be highly adherent without missing a single dose, which can be challenging for those also facing difficulties such as financial insecurity. In the context of Kampala, Uganda’s urban capital, it has been suggested that healthcare accessibility is made difficult by several physical and social barriers. However, knowledge of the extent to which such barriers, especially geographical barriers might influence HIV treatment success is lacking. This is a mixed methods study which examines geographical barriers to adherence within the socio-economic context of Kampala. Using data from a survey administered to individuals on treatment at the Joint Clinical Research Center (JCRC) in Kampala (n=149), the study employs logistic regression to examine the association between geographical barriers and treatment outcomes. Semi-structured interviews (n=30) were also conducted to deepen our understanding of lived experiences with HIV treatment. Results were unexpected, suggesting that participants living more than two hours away from the treatment facility were actually less likely to miss their daily dose of medication (OR = 0.33, p < 0.05), compared to those living in proximity to the treatment center. Findings from the interviews helped to explain these paradoxical findings, as it was reported that PLWH prefer clinics further from their home to avoid being recognized. The effect of HIV stigma was reported to further impact adherence at home and in workspaces, as PLWH felt pressured to take medication in secrecy. The results of our regression suggested that high-income employment (OR = 3.82, p < 0.05) and partnered relationship status (OR = 4.28, p < 0.05) were predicted to increase the probability of missing doses. Challenges to HIV treatment adherence such as stigmatization and transportation costs must therefore be considered in conjunction with one another, as determinants of health are overlapping and inextricable.
Summary for Lay Audience
In recent decades, the development of HIV treatment medications has made it possible for those diagnosed with HIV to live longer and healthier lives. Treatment programs are now widespread across sub-Saharan Africa, including Uganda, with many programs offering medication for free. However, research shows that people living with HIV can face challenges which prevent them from accessing the medications, even though the medications are offered free of charge. For HIV treatment to be effective, the medication must be taken consistently, without missing any doses. Adherence can be defined as the degree to which someone takes their medication as prescribed. This research thus examines potential barriers to adherence, such the distance to the treatment center. In this study, 30 people on HIV treatment at the Joint Clinical Research Center (JCRC) in Kampala, Uganda were interviewed about the challenges they face in adhering to treatment regimens. Surveys were also completed by 149 people on HIV treatment at the JCRC. Surprisingly, the survey data indicated that those who lived furthest from the clinic (over two hours away) actually had the lowest probability of reporting missed doses. These unexpected findings can be explained in the context of the results from the study’s one-on-one interviews. It emerged from the interviews that those on HIV treatment prefer clinics further from their home to avoid being recognized. Further, based on survey data, those with high-income employment and a partner were most likely to report missing doses, compared to those who were unemployed and single. The effect of HIV stigma was reported in the interviews to impact adherence at home and in workspaces, as people on HIV treatment often feel pressured to take medication in secrecy. These results are significant in that they provide direction for public health policies which seek to maximize treatment success. The results suggest that stigma is an important challenge faced by people on HIV treatment. Initiatives in and around Kampala should therefore seek to raise awareness surrounding HIV and HIV treatment, in order to minimize the stigmatization of people living with HIV.
Bruser, Gabrielle, "Examining Geographic and Social Barriers to HIV Treatment Adherence in Kampala, Uganda" (2020). Electronic Thesis and Dissertation Repository. 7252.
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