Dealing with HIV as a chronic disease in Africa

March 31, 2014
Dealing with HIV as a chronic disease in Africa
A peer support group in Tete, Mozambique. Credit: Freya Rasschaert

Since 2004, the number of patients on antiretroviral drugs in Sub-Saharan Africa has increased 24 times, to 6.9 million*. HIV has become a chronic disease. A lifelong strict adherence to treatment is necessary. Health systems in Southern Africa are not equipped to maintain an unprecedented large number of patients in life-long treatment. Alternatives are therefore urgently needed. ITM researcher Freya Rasschaert explored innovative solutions that take the needs of patients and the local reality into account. Rasschaert will receive a doctorate on Friday (March 28) at the Vrije Universiteit Brussel for her research in Ethiopia, Malawi, Mozambique and Zimbabwe.

In order to facilitate access to lifelong antiretroviral therapy (ART), care services were decentralized in these countries to peripheral health centres. Many of these peripheral centres are not equipped or adapted to this extra work pressure and to deal with the number of additional patients, however. Malawi and Ethiopia are two examples of how this deficiency can be addressed by delegating tasks to lower health frameworks and by creating new functions dedicated to HIV care without compromising the quality of the care.

Despite the contribution of enhanced health structures to improve access to ART and better retention of patients, this approach remains insufficient: "As long as a patient is sick, a health centre remains the preferred place for treatment, but you can't expect a fit HIV patient on ART to travel for two to three hours ever month just to fetch his or her pills. Furthermore, all peripheral health centres will be overcrowded and saturated within a short amount of time," says Rasschaert.

According to Rasschaert, treatment models of other chronic diseases, with the emphasis on 'self-management', can be applied to HIV care. Health care providers then no longer carry the major responsibility, but are mainly involved in teaching the necessary skills and knowledge to help patients cope with their disease themselves and to accompany them during this process. "This way people with HIV actively participate in the care of their chronic illness and at the same time it reduces the work pressure in the health centres, providing more time for the health staff to deal with the acutely ill."

Most of the chronic care models in developed countries can count on the support of strong health systems and multidisciplinary teams, which is rarely the case in countries with limited resources. That is why other support mechanisms, such as 'peer support' and social engagement, are so important.

The community-based treatment model in Tete, Mozambique, is a good example of how patients can play an active role in their own care and the care of fellow sufferers. Groups formed by patients stable on ART ensure monthly access to through a rotating medication retrieval system. They also offer support in the therapy adherence and a protected environment in which can freely discuss their daily problems and challenges.

"People with HIV and the community around them can play an important role in keeping people in treatment, but that's no excuse not to tackle the 's problems. Stronger health systems and innovative patient-centered care should go hand in hand with lifelong HIV care," concludes Rasschaert.

Rasschaert made use of literature studies, analysis of routine data, retrospective cohort analyses and qualitative research methods to come to her conclusions.

Explore further: Cardiovascular patients with HIV require unique treatment options

Related Stories

Cardiovascular patients with HIV require unique treatment options

October 3, 2016
Cardiovascular disease has become the leading cause of death for those living with HIV, as the infection has moved from a terminal disease to a chronic illness.

CDC urges prevention, early recognition of sepsis

August 24, 2016
(HealthDay)—Many cases of life-threatening sepsis could be recognized and treated long before they cause severe illness or death, according to an Aug. 23 Vital Signs report from the U.S. Centers for Disease Control and ...

Palliative care barriers must be addressed for heart/stroke patients

August 9, 2016
A new policy statement on palliative care, issued today by the American Heart Association, highlights how critical this care is to Americans with heart disease or stroke, and makes recommendations on how to address the current ...

Patient, family advisors can play key role in practices

August 23, 2015
(HealthDay)—Practices can employ patient and family advisors in order to help them focus on patient-centered care needs, according to a report published by the American Medical Association (AMA).

Medicaid patients need support to use primary care rather than emergency rooms

May 14, 2015
More than half of all Medicaid enrollees prefer the "one-stop shop" of a hospital emergency department to receive care for conditions that could be treated effectively at a primary care clinic, according to an article by ...

Adherence clubs keep HIV patients in, viral levels down

February 26, 2016
"Adherence clubs" can help people living with HIV stick to their medication regimens, according to research presented at the Conference on Retroviruses and Opportunistic Infections in Boston.

Recommended for you

Scientists elicit broadly neutralizing antibodies to HIV in calves

July 20, 2017
Scientists supported by the National Institutes of Health have achieved a significant step forward, eliciting broadly neutralizing antibodies (bNAbs) to HIV by immunizing calves. The findings offer insights for HIV vaccine ...

Heart toxin reveals new insights into HIV-1 integration in T cell genome

July 20, 2017
Human immunodeficiency virus (HIV)-1 may have evolved to integrate its genetic material into certain immune-cell-activating genes in humans, according to new research published in PLOS Pathogens.

Scientists capture first high-resolution image of key HIV protein transitional state

July 13, 2017
A new, three-dimensional snapshot of HIV demonstrates the radical structural transformations that enable the virus to recognize and infect host cells, according to a new study led by scientists at The Scripps Research Institute ...

Barrier to autoimmune disease may open door to HIV, study suggests

July 11, 2017
Researchers from the University of Colorado School of Medicine have discovered that a process that protects the body from autoimmune disease also prevents the immune system from generating antibodies that can neutralize the ...

Team tests best delivery mode for potential HIV vaccine

June 20, 2017
For decades, HIV has successfully evaded all efforts to create an effective vaccine but researchers at The Scripps Research Institute (TSRI) and the La Jolla Institute for Allergy and Immunology (LJI) are steadily inching ...

Mathematical modeling uncovers mysteries of HIV infection in the brain

June 19, 2017
After uncovering the progression of HIV infection in the brain thanks to a new mathematical model developed by a UAlberta research team, clinicians and researchers are developing a nasal spray to administer drugs more effectively.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.