Linking optimal adherence, morbidity and mortality to HIV/STIs;knowledge as a means of empowering LGBTIQQ to manage HIV

LGBTIQQ, provider-bias, food and transport costs: confronting hardships to ART adherence in Uganda and Kenya

MARPs in Uganda a local NGO, embarked on synthesizing reports from all its activities and uses standard knowledge development methods. Under the program “structural barriers to ART adherence in the Global South,” one of the the themes that the NGO is obsessed about is the relation between optimal adherence, morbidity and mortality from HIV/STIs. At MARPs in Uganda, we followed worked with LGBTIQQ in two Kampala-based and 1 Nairobi-based sites followed from 2014-2017. Some LGBTIQQ were living with HIV; had disruptions which affected ART adherence in 2014-2016. LGBTIQQ consumers fail to achieve optimal adherence, risking drug resistance and negative treatment outcomes. This review sought to find out why.

MARPs in Uganda a local NGO followed persons living with HIV who were attached to no-user fees ART accredited facilities. They were regularly provided with cash to purchase food and transport to clinics in Uganda. Following LGBTIQQ-related persecution in Uganda, some faced displacement. There are those who had to be provided housing support and some left for Kenya to seek asylum. Through an online rapid appraisal method using of a Whatsapp group whose number was shared, Western Union money Transfer services it was possible to do a problem diagnosis of issues affecting ART adherence.

Rent, food and transport to and from clinic were identified as three most important factors affecting adherence. Some were diagnosed and prescribed 2nd line treatments. This also meant long waiting times once they were refugees. undermines the sustainability of African ART programs. 

Identifying context-specific hardships to adherence and implementing interventions to address them. ART users reported other related costs e.g. transport, rent and food expenses, registration and user fees at private health facilities, and lost wages due to long waiting times) as main obstacles to optimal adherence. Side effects and hunger continued as concerns among some. Some ART users find it hard to take their drugs when they are among people to whom they have not disclosed their HIV status. 

Recommendations: (i) patients trained in managing drug adverse effects; (ii) food and subsistence costs become integral to ART programmes; (iii) recurrent costs to users can be cut down by providing three-months’ refills; and (iv) trained LGBTIQQ community-based peers or navigators play an important role in this follow-up care.


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