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Mark Hawken, MD1, Avina Sarna, MD MPH2, Susan Kaai2, Kishor Mandaliya, MD3, and Johannes Van Dam, MD MPH4. (1) ICRH, International Centre for Reproductive Health, P O Box 91190, Mombasa, Kenya, (2) Horizons Program, Population Council, 53 Lodi Estate, New Delhi, 110003, India, (3) Department of Pathology, CPGH, Coast Province General Hospital, Mombasa, Kenya, (4) HORIZONS, HORIZONS/Population Council, 4301 Connecticut Avenue NW, Suit 280, Washington DC, WA 20008, 202-237-9406, jvandam@pcdc.org
Background: ART programs are being initiated in several countries. Of foremost concern is the ability of PLHA to maintain 95% adherence. Prior to developing a modified-directly observed therapy (m-DOT) intervention to promote adherence, researchers conducted a formative assessment to explore the acceptability of different approaches.
Methods: In-depth interviews with 38 (18 men, 20 women) purposively selected PLHA; 6 FGDs with 31 health workers, 7 peer educators and 7 community health workers and 4 key informant interviews were conducted in Mombasa (August, 2002).
Results:
Most PLHA preferred a health facility-based follow-up (29/38) vs home-based follow-up by health workers mainly because of perceptions of greater confidentiality (12/29), better care and monitoring (9/29) and a sense of independence(6/29). There was convergence of findings from both PLHA and HWs over barriers to a health-facility based m-DOT strategy: distance from health centres, severe ill health, transportation-costs, time-off from work. HWs identified practical strategies to overcome some of these barriers such as satellite-observation sites, early opening hours for employed PLHA and using community HWs to follow up severely ill PLHA. HWs felt positive about their inclusion in the formative assessment and the participatory approach to project planning.
Conclusions:
The formative assessment was found to be a valuable process in identifying potential strategies for fostering adherence while addressing the needs and concerns of PLHA and HWs. Findings have been used to develop a two-arm randomized-controlled operations research study, in Mombasa, comparing a primarily facility-based, directly-administered-ART intervention with a standard adherence counseling intervention.
Learning Objectives:
Keywords: Adherence, Antiretroviral Combination Therapy
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.