Unplanned antiretroviral treatment interruptions in southern Africa how should we be managing these 英文参考文献.docVIP

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Unplanned antiretroviral treatment interruptions in southern Africa how should we be managing these 英文参考文献.doc

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Unplanned antiretroviral treatment interruptions in southern Africa how should we be managing these 英文参考文献

Veenstraetal.GlobalizationandHealth2010,6:4 /content/6/1/4 REVIEW OpenAccess Unplannedantiretroviraltreatmentinterruptions insouthernAfrica:howshouldwebemanaging these? NinaVeenstra1*,AlanWhiteside1,DavidLalloo2,AndrewGibbs1 Abstract Adherencetoantiretroviraltherapyisessentialformaximisingindividualtreatmentoutcomesandpreventingthe developmentofdrugresistance.Itis,however,frequentlycompromisedduetopredictable,butadverse,scenarios inthecountriesmostseverelyaffectedbyHIV/AIDS.Thispaperlooksatlessonsfromthreespecificcrisesinsouth- ernAfrica:the2008floodsinMozambique,theongoingpoliticalandeconomiccrisisinZimbabwe,andthe2007 publicsectorstrikeinSouthAfrica.Itconsidershowthesecrisesimpactedonthedeliveryofantiretroviraltherapy andlooksatsomeofthestrategiesemployedtomitigateanyadverseeffects.Basedonthisitmakesrecommen- dationsforkeepingpatientsontreatmentandlimitingthedevelopmentofdrugresistancewheretreatment interruptionsareinevitable. Review amongstthosethatarepoorlyadherentareundeniable. Antiretroviraltherapy(ART)adherenceiscompromised ArecentstudyinSouthAfricaconcludedthosepatients undersomesituationsincountriesmostheavilyaffected claiminglessthan80%oftheirprescription refills were byHIV/AIDS.Afrequentlycitedmeta-analysisaffirmed overthreetimesmorelikely todiethanthoseclaiming thatpatientsinsub-SaharanAfrica(sSA)recordadher- morethan80%[21]. ence levels as good as those documented in the rich world[1].However,unfavourablecontextslimitanindi- adherence goesbeyondtheindividual level. Itbecomes vidual’scontrolovertheirowntreatment. a public health issue when drug resistant viral strains The development of drug resistance due to poor ManyearlyARTprogrammeswhichwerethesubject are transmitted and this has been a major concern of adherence studies in sSA captured a set of circum- amongstgovernmentsandhealthagencies.Astreatment stances that cannot consistently be maintained in the wasintroducedinsSA,wewerewarnedofasituationof