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Unplanned antiretroviral therapy (ART) treatment interruptions in sub-Saharan Africa
Project Started : September 2008
Project Ends : April 2009
Lead Researcher : Nina Veenstra
Project Donor : JFA
Overview
Adherence to antiretroviral therapy is important to optimise treatment outcomes and prevent the development of drug resistance. It is however compromised under a number of situations in the countries most heavily affected by HIV/AIDS. The question we are concerned with is: 'How to keep people on treatment?'
The answer lies in an understanding of why adherence is important; what levels of adherence are needed to ensure that treatment remains effective; how different types of crisis affect people's access to treatment; and how patients and service providers respond to such difficulties.
This research considers the longer term impact of unplanned ART treatment interruptions and makes suggestions as to how they might be avoided and managed in future, based on a series of case studies. More specifically, it looks at problems with health system functioning and ART delivery during:
- The 2007 public sector strike in South Africa,
- The ongoing political and economic crisis in Zimbabwe, and
- The 2008 floods in Mozambique.
While the project is primarily a literature review, a small number of interviews with key informants are also to be undertaken to enhance our understanding of the impact of these crises on delivery of ART and the strategies undertaken to mitigate the situations, by those on treatment and those in the health system, for improved future planning.
Unplanned Interruptions of ART in Southern Africa, is a collaborative project between HEARD and the Liverpool School of Tropical Medicine. Researchers are:
- Nina Veenstra who is a Research Associate of HEARD
- Alan Whiteside who is a Professor and the Director of HEARD
- David Lalloo who is a Reader in Tropical Medicine and Director of the Wellcome Trust Tropical Centre at the Liverpool School of Tropical Medicine.
- Andrew Gibbs is a Researcher at HEARD
Funding for this work was provided by HEARD and the Addressing the Balance of Burden of AIDS (ABBA) DFID Research Partners Consortium.
Research Questions
To develop a better understanding of how different types of crises affect individuals’ ability to remain adherent to ART. Key questions:
- What are the effects of treatment interruption at an individual and population level?
- What were the specific effects of the public sector strike in South Africa, the 2008 floods in Mozambique, and the political and economic collapse in Zimbabwe, on adherence to ART.
- What is the long term impact of such unplanned interruptions in ART treatment?
Strategic Questions
- Research programme 2
- Strategic objective 3
Expected Knock-On
The increased understanding of the effects of unplanned treatment interruptions may assist in the development of more effective strategies to deal with situations in which unplanned ART interruptions occur.
Project Impact
The research report and policy brief will circulated as widely as possible to organisations and individuals who may be interested in developing response strategies to unplanned ART treatment interruptions.
Brief Description
- Literature review on ART adherence and the effects of ART interruptions.
- Interviews with key informants in NGO's and government departments.
Collaborators
- Medicins sans Frontiers, Mozambique and Zimbabwe
Key Phases
| Started | Completed | Description |
|---|---|---|
| September 2008 | October 2008 | Literature Review |
| October 2008 | February 2009 | Interviews |
| March 2009 | August 2009 | Write up |
Outputs and Activities
- Unplanned ART Treatment interruptions in Southern Africa: a literature review Click here for more information.
- Unplanned ART treatment interruptions in southern Africa: What can we do to minimise the long-term risks? Click here for more information.
Related News
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Physicians for Human Rights (PHR) have published a report on the impact of the socio-economic collapse in Zimbabwe, based on fieldwork there. Health in Ruins, details the impact of the collapse on Zimbabwe’s health sector, including the impact on access to ART.
For more information, visit http://physiciansforhumanrights.org/library/report-2009-01-13.html
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Two recent articles in Conflict and Health, an open access journal, detail the impact of Kenya’s post-election violence in late 2007 and early 2008 on children’s and adult’s access to HIV services and adherence to ART.
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