Personal barriers to antiretroviral therapy adherence: case studies from a rural Uganda prospective clinical cohort.

BACKGROUND: Although good adherence to antiretroviral therapy (ART) is essential for successful treatment outcomes, some patients may have specific personal barriers to ART adherence. OBJECTIVES: To study specific personal barriers to ART adherence. METHODS: Quantitative data on patients' health status, ART adherence, CD4 cell counts and viral loads were collected, and qualitative data on life experiences of five patients with poor ART outcomes and adherence were also collected. RESULTS: Out of 35 patients with poor immunological and virological ART outcomes, 17 (49%) also had poor ART adherence. Patient 1 had no living child and did not disclose her HIV serostatus to her spouse because she wanted to have a child. Patient 2 was an orphan with neither social nor family support. Patient 3 stopped ART when she conceived, returned to the study clinic when pregnant again and was sickly. She was switched to second-line ART with satisfactory outcomes. Patient 4, a 14 year old orphan had missed ART for 2 months when his treatment supporter was away. Patient 5 aged 66 years stopped ART which he blamed for his erectile dysfunction. CONCLUSION: ART adherence counselling should target specific personal barriers to ART adherence like: lack of family support, health and sexual life concerns, desire to have children and family instability.

Recognition, treatment seeking behaviour and perception of cause of malaria among rural women in Uganda.

This study was conducted in order to understand how women in rural Uganda recognise malaria, their treatment-seeking behaviour when malaria is suspected and how the perception of cause may influence this behaviour. Focus group discussions and semi-structured interviews were held with women selected from the general population and from women attending health clinics for both preventive and curative services. The main finding of this study was that the word used for malaria in the local language, omusujja, covered a broad symptom complex which did not consistently correspond to the clinical case definition of malaria. Since there was no specific word for 'malaria', the study was broadened to encompass omusujja. The women reported that omusujja was an important health problem which had various causes, including poor diet, environmental conditions, and the bites of mosquitoes. The symptoms associated with omusujja were quite varied and ranged from generally 'feeling unwell' to a specific fever diagnosis (usually in children) of 'a rise in body temperature'. Women recognised that omusujja posed a particular threat to pregnant women. Preventive actions recommended by the women were in line with their perceptions of cause. The respondents usually mentioned the use of herbs as the first treatment action, followed by the purchase of tablets from shops, with the final recourse being the formal health sector if the previous actions had not effected a cure.(ABSTRACT TRUNCATED AT 250 WORDS)

PIP: To facilitate the design of malaria prevention and control programs in tropical Africa, a qualitative investigation of treatment seeking behaviors and perceptions of the causes and symptoms of malaria was conducted in a rural area in South Western Uganda's Masaka District. Components of the investigation included focus group discussions involving 42 participants recruited from women's clubs and prenatal and child health clinics, semi-structured interviews with 395 female outpatients 13 years of age and above and adult women escorting young children to government subdispensaries for treatment of a new malaria episode, and household interviews with 64 mothers. In this rural community, there is no specific word for malaria; rather, the word "omusujja" is used to refer to malarial symptoms as well as any kind of fever. Respondents consistently identified omusujja as the most prevalent, serious disease in their community. They linked its causation to food and drink, environmental conditions, vectors such as mosquitoes, and other illnesses. There was widespread awareness that omusujja presents differently according to age group, e.g. fever, refusal to suck, crying, vomiting, and mouth sores in infants as compared to miscarriage, vomiting, weakness, chills, and joint pain in pregnant women. Treatment is initiated promptly, although it mainly consists of use of local herbs; if the herbs fail to reduce the fever, hospital care is sought. Preventive methods cited included boiling water, cleaning cooking utensils, avoiding raw mangoes and roasted maize, and keeping mosquitoes out of the home. Recommended is a health education campaign emphasizing the role of mosquitoes in malaria transmission and the need for prompt medical intervention.

Building Community Capacity to Cope with Adversity: The Role of Traditional Support Networks

"Introduction: In parts of Uganda the Impact of the AIDS epidemic is overwelming. Traditional community support networks have; however; been weakened due to the past economic and political turmoil; aid agencies are increasingly involved in providing ""emergency aid"". Objective: To examine how best external aid can contribute to the building of a self-sustainable community developmental activities in approximately 50 villages using a community based approach. The role of the unit is limited to facilitating the developmental process by providing expertise and advice to communities on how to harness available resources for development. Methods: The MRPA community support and counseling unit was set up in 1990 and carries out health; counselling; educational and developmental activities in approximately 50 villages using a community based approach. The role of the unit is limited to facilitating the developmental processes by providing expertise and advice to communities on how to harness available resources for development. Results: In two years more than 30 village committees were established to provide support for community health work. Volunteer community health workers and birth attendants carry out community health activities. The number of active women's groups in the area increased from nil to 13. Particularly interesting is the recent self initiated revival of a ""Munno Mu Kabi"" group (litterary: yours in need); by a group of women from 7 villages. Members meet forthnightly to discuss the problems on needy familities in their villages; in particular those with AIDS patients. These families are visted and advice is given as well as material assistance. To date the group has helped 56 families. Conclusion: Our experience indicates that external support can result in community initiatives which are suggestive for the existance of a community developmental capacity; it is rather early; however; to know if this capacity is sustainable . The revival of a traditional system suggests the external agencies aiming at community capacity development should explore the use of traditional support structures."