As many of you are familiar, ART is an antiretroviral treatment initiated to HIV patients based on their clinical stage. According to World Health Organization’s guidelines in resource-limited settings, ARV is initiated according to the organization’s definition of AIDS stages based on laboratory and clinical assessments. Once ART is initiated, if taken adherently, it reduces immune suppression, slows disease progression, prolongs survival and improves the quality of life. If, however, the treatment is not adhered to due to other reasons such as stigma, feeling better, depression, being fed- up of drugs etc, then it will lead to viral replication and the development of drug resistant viral strains. In such cases, the resumption of first-line regimen may not mitigate replication of drug resistant strains calling for the initiation of second or third-line treatments. This has its own consequences as second and third-line treatments are more costly and the shift to higher-lines also limits the choice of medications available to patients.
The other problem with non-adherence to ART is that the drug resistant strains can be transmitted to others whereby new HIV infected individuals become resistant to treatment without having taken the medication before. This is a major public health concern because there’s already limited availability of drugs’ choice in the country (Adherence to ART in adults, population Council, 2004). Moreover, the availability of ART in Ethiopia is limited to first and second-line regimens, which means once a patient switches to second-line regimen, there’s no other line remaining to be administered as a last resort if the patient has to switch again.
With this in view, I wanted to see what the adherence level was at the Black Lion Hospital and went to the ART clinic there to speak to Sr. Aregash. Much to my surprise and joy I was able to find that there were not many lost to non-adherence due to follow-ups done by what they call ‘expert patients’. These ‘expert patients’ pull out the addresses of ART users and follow-up on those who have not come to take their medications on time. There is, however, a small number that were lost to moves without a forwarding address and others due to take-up of holy water (tsebel). After persistent follow-up by the ‘expert patients’, these too were returned to resume treatment based on their CD4 count or viral load. There was one patient, however, who was admitted due to non-adherence because he thought he had gotten better, which made me wonder whether he had been advised adequately or not. Although I was not able to speak to him, I was glad to hear that he was receiving the necessary treatment.
In conclusion, although it was good news that Black Lion’s ART users have high adherence levels, I hope the same experience holds true both in other health centers and outside Addis. As I mentioned previously non-adherence to ART has dire individual and public health consequences. In light of this, to hear of non-adherence due to the take-up of tsebel and other forms of religious ‘remedies’ is a bit worrisome in such a religious country as ours. Equally worrisome was ART users’ non-adherence on account of better health. Thus, I thought I would close by making a call to all religious leaders to promote treatment adherence among their followers and also for ART providers to give adequate information for the sake of the patients’ health and that of the nation’s as a whole.
