uu.seUppsala University Publications
Change search
ReferencesLink to record
Permanent link

Direct link
Inadequate pre-antiretroviral care, stock-out of antiretroviral drugs and stigma: Policy challenges/bottlenecks to the new WHO recommendations for earlier initiation of antiretroviral therapy (CD < 350 cells/mu L) in eastern Uganda
District Health Office, Iganga District Adminstration, Iganga, Uganda.
Northern Uganda Transition Initiative, Gulu, Uganda.
Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda.
Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda.
Show others and affiliations
2010 (English)In: Health Policy, ISSN 0168-8510, Vol. 97, no 2-3, 187-194 p.Article in journal (Refereed) Published
Abstract [en]

Objective: This study explores reasons for late ART initiation among known HIV positive persons in care from a client/caretaker perspective in eastern Ugandan where ART awareness is presumably high yet AIDS related mortality is a common function of late initiation of ARVs. Methods: In Igangs, Uganda we conducted in-depth interviews with clients who started ART at 50-200 CD4 cells/mu L and those initiated very late at CD4 < 50 cells/mu L. Focus-group discussions were also conducted with caretakers of clients on ART. Content analysis was performed to identify recurrent themes. Results: ARV stock-outs, inadequate pre-antiretroviral care and lack of staff confidentiality were system barriers to timely ART initiation. Weak social support and prevailing stigma and misconceptions about ARVs as drugs designed to kill, cause cancer, infertility or impotence were other important factors. Conclusion: If the new WHO recommendations (start ART at CD4 350 cells/mu L) should be feasible, PLHIV/communities need sensitization about the importance of regular pre-ARV care through the local media and authorities. The ARV supply chain and staff attitudes towards client confidentiality must also be improved in order to encourage timely ART initiation. PLHIV/communities should be sensitization about drug package labeling and the use and importance of ARVs. Stronger social support structures must be created through public messages that fight stigma, enhance acceptance of PLHIV and encourage timely ART initiation.

Place, publisher, year, edition, pages
2010. Vol. 97, no 2-3, 187-194 p.
Keyword [en]
Policy challenges, Bottlenecks, WHO ART Recommendations
National Category
Medical and Health Sciences
URN: urn:nbn:se:uu:diva-134884DOI: 10.1016/j.healthpol.2010.06.003ISI: 000282111300013OAI: oai:DiVA.org:uu-134884DiVA: diva2:374102
Available from: 2010-12-02 Created: 2010-12-02 Last updated: 2011-01-04Bibliographically approved

Open Access in DiVA

No full text

Other links

Publisher's full text

Search in DiVA

By author/editor
Peterson, Stefan
By organisation
Department of Women's and Children's Health
In the same journal
Health Policy
Medical and Health Sciences

Search outside of DiVA

GoogleGoogle Scholar

Altmetric score

Total: 133 hits
ReferencesLink to record
Permanent link

Direct link