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Zambia: Research into ART highlights barriers to access

The African Jesuit AIDS Network (AJAN) has launched a research campaign to gauge the extent Africa of real access to antiretroviral treatment (ART) of people living with HIV in sub-Saharan Africa. The home-based care (HBC) program of Chikuni Parish in rural Zambia piloted the AJAN research questionnaires and presented their findings to national stakeholders in Lusaka in April. The director of Chikuni HBC, Kelly Michelo SJ, reports.

Access to antiretroviral treatment (ART) comes up against barriers at the individual, institutional and national levels in Zambia. At the individual level the long distances that need to be covered to reach treatment facilities have a negative impact, not least because people living with HIV need to take time off work – something may can ill afford – just to go to pick up their medication. At the institutional level, congested pharmacies translate into long hours of waiting. And at the national level, there is a shortage of trained staff and of antiretroviral drugs (ARVs).

This is what emerged during an event organized by the Chikuni home-based care (HBC) project on 30 April to present its research findings about access to ART to national stakeholders. Late last year, Chikuni HBC interviewed 181 people in the pilot phase of an AJAN research and advocacy campaign to assess barriers standing in the way of universal access to ART.

The Jesuit Centre for Theological Reflection (JCTR) in Lusaka hosted the presentation. Among those who attended were UNESCO, the World Health Organisation (WHO), the National AIDS Council, SHARe II, Dette Resources Foundation and Zambia Daily Mail, a media house that produced a story for their newspaper.

During the discussion following the presentation, it emerged that the National AIDS Policy is being revised to address current challenges in the struggle against the disease. The new policy highlights successes in roll-out of treatment in Zambia over the years but also underlines the dismal performance in scaling up pediatric and adolescent ART.

A number of recommendations for improved access were mooted by those present, chief among them the decentralization of ART distribution in Zambia. There was unanimous agreement that the current ART model used in the country is a poor one. Better solutions were cited, like the community model adopted in Mozambique, which has achieved lots of success in terms of retention in care and reduced loss-to-follow-up.

However, we were aware that changes need to take place for the decentralization model to become a reality because right now so-called ‘pharmacy vigilance’ prevents the handling of ARVs by people other than medical personnel. It was noted that this trend goes against the new WHO guidelines on the use of ART; they encourage entrusting the initiation and maintenance of ART to ordinary people who are trained. Task shifting at the points of testing, maintenance and monitoring of ART, involving community-based workers, would lead to a helpful move away from centralized health facilities.

Another suggestion was that some medical staff should be helped to understand that AIDS is not only a clinical problem but also a public health issue requiring models that are holistic in approach. And there was a call to revive support groups and home-based care to enhance access to ART. The draft national policy under review goes in that direction but it remains to be seen just how much it will be implemented on the ground. It was also recommended that treatment regimens be simplified, with clear instructions, so that people will find medicine easier to take instead of having many different tablets.

Chikuni HBC presented a pilot model for community-based ART distribution based on the outcomes of its research. This will build on the structure of the HBC, which is based on self-help groups in villages that most people on ART belong to. We hope that this will make it easier for people to access and adhere to their medication.

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