HIV TREATMENT FOR WOMEN IN UGANDA: INCREASING ACCESS THROUGH INTEGRATED SERVICE PROVISION

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HIV TREATMENT FOR WOMEN IN UGANDA INCREASING
ACCESS THROUGH INTEGRATED SERVICE PROVISION

• J McGrath1, S Rundall1, D Kaawa-Mafigiri1, N
  Kakande2
• 1Case Western Reserve University 2Joint Clinical
  Research Centre
• Funded by Center for AIDS Research (CFAR), Case
  Western Reserve University, Michael Lederman,
  M.D., PI (NIH grant number AI316219)

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• Health care seeking is a process
• Available health care is not necessarily
  accessible
• Womens ability to access available care merits
  special attention

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Study objectives

• Identify barriers to HIV care for women in
  Kampala, Uganda
• Identify what HIV service providers consider the
  primary barriers to accessing HIV care
• Develop recommendations to improve Ugandan
  womens access to HIV treatment

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Methods

• Interviews with 22 HIV service providers in
  Kampala
• Illness narratives from 101 HIV women receiving
  care at JCRC

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Key findings

• Providers and patients report delays in seeking
  HIV testing and treatment
• Addressing delays will improve access to care

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Providers

• 82 (14) of providers report that clients enter
  care too late to receive maximum benefit from
  treatment.
• Clients have very low CD4 counts or they are very
  sick when presenting for treatment.

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Providers reasons for delays

• lack of (correct) knowledge about ARVs
• lack of money
• hesitancy to be tested
• fear of stigma if status is known
• They do not want to be seen lining up here at
  the facility to get treatment. (female,
  counselor)

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Womens narratives confirm existence of delays

• Delay 1 from suspicion of HIV to testing
• Delay 2 HIV test to treatment

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Womens reasons for delays

• Fears and concerns about risks of drugs
• "I fear that they may have disastrous side
  effects which the doctors may not have known by
  now.
• Funds
• At one time I did not have any money and I
  spent two months without taking ARVs.

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Stigma, with resulting secrecy

• I have never told any of my children and some
  close friends.  I dont trust they could keep my
  secret. HIV positive people are still being
  stigmatized and that is one of the reasons people
  do not disclose.
• Lack of symptoms
• I knew my status in 1995 . I came to JCRC
  after falling sick and getting admitted seven
  times in 2001.

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Two primary cues to action- delay 1

• 31 of the women sought testing because of the
  illness or death of a partner
• 23 of the women sought testing due to her own
  illness

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Primary cue to action delay 2

• 40 reported no delays because they were sick
  when tested
• I began falling sick in 2000 December with on
  and off malaria and lost weight steadily until it
  was so obvious that I either had HIV or something
  else was eating me up. Throughout 2001 I fell
  sick and got admitted thrice with severe malaria
  and diarrhea. I however delayed to test for HIV
  because I did not have other reason to suspect.

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• For 35 of women who delayed between testing and
  treatment the cue to action was their symptoms.
• Although my husband died of AIDS in 1993, I had
  never fallen sick until April 2002. tested
  positive in 1994.

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Our recommendations

• Recognition that Free Drugs ? Quality Care
  (Science, 28 July 2006) reminds us that quality
  HIV care begins with access to quality primary
  health care.
• Integration of HIV care and treatment services
  with other health care services can increase
  womens ability to access HIV care and treatment
  earlier in the HIV disease spectrum.

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Increasing Access through Integrated Service
Provision

• Scale up must increase access to HIV/ARV
  training for providers and improved integration
  of patient services.
• Future research to explore womens treatment
  seeking patterns in-depth to determine how best
  to increase the accessibility of available care.

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• "I was rescued by these drugs from the pangs of
  death".

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Acknowledgements We thank the women and the
health care providers who participated in this
study and the staff at the Joint Clinical
Research Centre for their assistance with the
study. Jude Tibemanya conducted interviews.
Stephanie McClure and Margaret Winchester
assisted with data entry and analysis.