Reasons why HIV-positive patients default on ARVs during the lockdown
Fear of contracting Covid-19, transport problems and economic reasons such as the increase in costs of travelling are some of the reasons that have kept many HIV-positive South Africans from collecting their medication during the lockdown, a new study has revealed.
The new research on the impact of the lockdown on decentralised antiretroviral therapy programmes, which was presented at the 23rd International Aids Conference on Wednesday, has also revealed that mistrust of the government and health sector’s management of Covid-19 has driven many HIV patients underground.
Lead researcher Jana Jarolimova, an infectious disease clinical and research fellow at Massachusetts General Hospital in the US, said among the 300 participants involved in the study, who received their treatment at pharmacies and community facilities as opposed to clinics, “the most commonly identified concerns regarding the pandemic were being infected with Covid-19, unable to work, and money running out”.
All participants were part of the central chronic medicine dispensing and distribution programme in urban Kwazulu-Natal.
Along those who feared infection, more than two-thirds or 68% of HIV patients anticipated barriers to the ART programmes in the future.
While many were worried about the economic impact of the lockdown and contracting Covid-19, Jarolimova said the majority or 51% who had managed to collect their ARVs “noted an increase in waiting time at pickup points” - something which they considered an inconvenience.
The Gauteng health department is one of the government departments that has spoken openly about the impact of lockdown on its antiretroviral therapy programme. In May the number of patients who failed to collect their TB medicines in that province was 1,090, while the number of patients who failed to collect their antiretroviral medicines was about 10,950.
The province measured medication collections for TB at 1.4% and 19.6% for HIV, prompting it to implement a track-and-trace plan to locate patients that had not collected their medication.
Meanwhile a randomised controlled trial by MSF in Khayelitsha’s adherence clubs, which compared six-month refills of ARVs compared to the standard two-month supply, has found that not only does issuing medication over the long term increase convenience to patients, but it improves their adherence to treatment. Patients that received the six-month refills reported reduced unintended disclosure, they had less worry about transport problems, and this increased health system efficiency.