Factors influencing uptake of antiretroviral drugs in Rakai District, Uganda.

Abstract

Introduction: About 75% of people living with HIV/AIDS (PLWHA) who need treatment with anti-retroviral therapy (ART) in low income countries have no access. The Uganda government’s distribution of free antiretroviral drugs (ARVs) was expanded in 2004. With expanded distribution of free ARVs, it was assumed that PLWHA would rush to receive ART. For example in Rakai District, it was anticipated that by the year 2005, about 4,000 PLWHA in the district would be on ARVs but only 1,250 have so far been enrolled for ARVs in the whole district. We investigated factors influencing use of ARVs in Rakai district of Uganda from October to December 2006. Objective: To elicit and understand possible barriers to use of free ARVs in Rakai district. The understanding of the factors influencing use of ARVs is a prerequisite for designing appropriate intervention programs. Methodology: We interviewed 38 key informants and 384 PLWHAs. It was a cross sectional study and both qualitative and quantitative methods of data collection were used. Data were collected on: education/mobilisation for use of ART, sources of information for ART, beliefs regarding use of ART, availability of social support, use of alternative medicine, stigma towards PLWHAs and use of ART, distance to ART centres, transport costs to ART centres, waiting time, PLWHAs attitudinal beliefs towards ART and on suggestions as how to improve the use of ART within the district. Qualitative data was recorded, translated and transcribed in English. Analysis was done using master sheets. Quantitative data was analyzed using Epi Info 2002 and SPSS 11.5 version computer programs. Odds ratios were used to test for associations and 95% confidence intervals for statistical significance testing. Results: Individual barriers: such as myths and misperceptions about ARVs as mentioned by 209/384 (54.4%) PLWHA, lack of information about free ARVs 258/384(67.2%) and traditional medicine that PLWHA use instead of ARVs285/384(74.3%) Relational barriers: such as stigma and fear of discrimination that prevent people from seeking for treatment or create a need for secrecy about using ARVs as mentioned by 254/384 (66.1%). Environmental barriers: such as overstaying at ART treatment centers, long distance to treatment centers and financial barriers such as lack of money for transport. The study found out that average waiting time at treatment centers was 8.36 hours, the median distance that people have to travel to treatment is 10.0 km and the majority of PLWHA interviewed 234/384 (60.9%) were earning less than 10,000 /= per month yet most of them use 5,000/= of family income to collect ARVs. Lack of food when their appetites improve was also mentioned as a barrier. Conclusion: Major barriers to use of free ARVs in Rakai district include: stigma and discrimination attached to HIV/AIDS; inadequate community education and mobilization, long waiting time at ART treatment centers and limited access of ART treatment centers. Recommendations: To reduce the barriers towards use of ART, there is need to: improve community education using innovative approaches such as music, dance and videos; increase the number of health care providers who are able to provide ART which may be possible through training nurses in provision of ART and use of other non health workers including PLWHAs in carrying some aspects of ART provision such as counseling and treatment supervisors and by reducing costs of transport through bringing ART nearer to where people live and through increasing the number of ART centres. Addition measures for reducing the barriers include instituting measures aimed at reducing stigma such as through greater involvement of PLWHA in demythsfying HIV/AIDS.