Final Report: Unplanned ART treatment interruptions in southern Africa: what can we do to minimise the long-term risks?
Adherence to antiretroviral therapy (ART) is important to optimize treatment outcomes and prevent the development of drug resistance. It is however comprised under a number of situations in the countries most heavily affected by HIV/AIDS. This report considers the longer term impact of unplanned ART treatment interruptions and makes suggestions as to how they might be avoided and managed in future. It is 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. It is based on a literature review and a relatively small number of interviews with health managers and clinicians in each country. This report contains five sections. The first is a look at the various undesirable outcomes of sub-optimal adherence and the critical levels of adherence required to avoid these. The second section reviews studies that have focused on the effects of treatment interruptions specifically, whether purposefully or unintended. The third is an investigation into what levels of adherence might be expected from patients on treatment in sub-Saharan Africa (sSA) and the factors hindering such adherence. The fourth section reviews three specific crises in southern Africa and the effect these had on ART delivery in particular. Finally, the fifth section attempts to identify potential strategies for keeping patients adherent on ART during a crisis, given what is known about patient and provider responses to the three crises studied.View full text