In March 2005, Tororo General hospital in Eastern Uganda started providing ART services to eligible HIV/AIDS patients. By February 2006, 162 patients were registed for ART care. It was however observed that patients were not always swallowing their medicines, and adherence levels to ARVs were only in about about 20 - 25% of the patients. This level of adherence was too low compared to the Ministry of Health (MOH) recommended 95% adherence levels for all patients on ART. Poor adherence can result in patients developing resistance to ARVs, poor clinical outcomes for patients and the public losing faith in the effectiveness of the drugs.
The HIV care team intensified adherence counseling by engaging more counselors in the clinic since they could be supported by counselors from antenatal and maternity clinics. We also involved expert clients to further boost our adherence effors, both at the clinic level and community/village level. Patients could relate to such expert clients. With support from CDC project, we engaged in radio broadcasts on local FM stations addressing adherence, stigma and disclosure. We made treatment supporters more involved in care and adherence counseling especially among pediatric clients. We involved health workers at the facility who were HIV+ to provide adherence coounseling and health education to our patients. We involved clients with good clinical improvement to give their testimonies and experiences on ARVs, and this was done monthly during clinic visits. We also introduced an appointments register from which the defaulting patients could be identified and followed-up, this was with funding from CDC. In addition, regular coaching from the HCI team motivated the clinic staffs to periodically review performance and test new changes.
There was significant improvement in adherence of ART patients to their medications, stigma went down and discrimination is now significantly reduced. Over the period, adherence levels have increased from 25% in February 2006 to 97% in August 2009 from where it stablized until January 2011 where it's still at 97% among 458 on ART then. The adherence level fluctuates between 95% and 100% mainly due to stock-outs of ARVs, which are centrally supplied by the National Medical Stores. The MoH recommended individual adherence is 95%. Another indication of good adherence among our patients is that we currently do not get many episodes of opportunistic infections among patients on ART. Of the 497 active patients on ARVs, only 09 are on second line regimen and that's because they have Karposis Sarcoma and not because of drug resistance. We have also observed increament in the number of patients now seeking care, both pre-ART and ART, where the average enrollment is about 51 patients per month.
We observed that patients relate better with their fellow patients in receiving and taking up information, that is why we adopted expert clients and health workers who are HIV+. In addition, for an HIV program to succeed it needs external funding since it cannot stand on it's own to follow-up defaulting patients and monitoring patients in care. Another lesson is that patients need to be given accurate information about HIV/AIDS and ART, and they should know why they are taking the drugs. We have also learned that addressing adherence has reduced cases of stigma and discrimination among our patients.
