tailieunhanh - báo cáo khoa học: "Unplanned antiretroviral treatment interruptions in southern Africa: how should we be managing these?"

Tuyển tập báo cáo các nghiên cứu khoa học quốc tế ngành y học dành cho các bạn tham khảo đề tài: Unplanned antiretroviral treatment interruptions in southern Africa: how should we be managing these? | Veenstra et al. Globalization and Health 2010 6 4 http content 6 1 4 H2 GLOBALIZATION . 7 AND HEALTH REVIEW Open Access Unplanned antiretroviral treatment interruptions in southern Africa how should we be managing these Nina Veenstra 1 Alan Whiteside1 David Lalloo2 Andrew Gibbs1 Abstract Adherence to antiretroviral therapy is essential for maximising individual treatment outcomes and preventing the development of drug resistance. It is however frequently compromised due to predictable but adverse scenarios in the countries most severely affected by HIV AIDS. This paper looks at lessons from three specific crises in southern Africa the 2008 floods in Mozambique the ongoing political and economic crisis in Zimbabwe and the 2007 public sector strike in South Africa. It considers how these crises impacted on the delivery of antiretroviral therapy and looks at some of the strategies employed to mitigate any adverse effects. Based on this it makes recommendations for keeping patients on treatment and limiting the development of drug resistance where treatment interruptions are inevitable. Review Antiretroviral therapy ART adherence is compromised under some situations in countries most heavily affected by HIV AIDS. A frequently cited meta-analysis affirmed that patients in sub-Saharan Africa sSA record adherence levels as good as those documented in the rich world 1 . However unfavourable contexts limit an individual s control over their own treatment. Many early ART programmes which were the subject of adherence studies in sSA captured a set of circumstances that cannot consistently be maintained in the longer-term as treatment is scaled up. In particular inconsistent drug supplies have been shown to be an important factor influencing adherence see for example 2-5 . Both direct and indirect costs a function of the broader socioeconomic environment also feature prominently in relevant research see for example 6-10 . Any threats to ART .