Fighting the tendency to default on HIV/Aids treatment

Brian Hayward

KEEPING TABS. . . A nurse at a Nelson Mandela Bay clinic shows one of the many medication shelves used for dispensing antiretrovirals (ARVs) to HIV-positive patients. Picture: Eugene CoetzeeAS more HIV-positive patients are put onto antiretroviral treatment (ART), doctors warn of the rising global phenomenon of patients defaulting on their medication “as soon as they feel better”.


But hard work by NGOs and a drive by government to counsel patients on how important it is to continue taking their daily concoction of pills before they begin treatment – coupled with a new electronic system of monitoring if patients miss a visit to the clinic – appears to be paying off.

The worry, say clinicians, is that with the complex regimen of antiretroviral (ARV) drugs, should patients skip treatment for more than three months at a time, their system could become immune to the most widely available line of ARV treatment, and have to be put onto a more complex second or third line.

There are about 1.5-million South Africans on ART, with about 26200 living in Nelson Mandela Bay.

The Health Department’s head of the HIV/Aids programme in the Bay, Nadiema van der Bergh, said despite the many people on ART in the city, just 97 had defaulted on their treatment long enough to warrant them being moved onto a second, more costly and more complex level of ART.

The minimal amount of defaulters points towards a successful adherence campaign.

“Defaulting has been a problem for a long time. To try and combat that we have adherence clubs which is like a support group,” said Treatment Action Campaign (TAC) researcher, Marcus Low.

“The problem of defaulting is very complex, because in rural areas the issue of transport is a major issue, especially when people have to travel half a day to get their treatment. There are advances, though, such as with more clinics, and medication being dispensed for two months at a time instead of one.”

Daygan Eagar, health researcher with watchdog organisation Section27, said the challenge was that when patients “don’t feel sick, they don’t take their medication”.

“We [South Africa] have managed to become quite successful when it comes to adherence,” Eagar said. “It might be a challenge when [ART is expanded to all HIV-positive patients with] CD4 counts 350 [and under]. But there are people in the country who have been on ART for 10 years now, and a lot of that has to do with work by organisations like the TAC, which has worked hard on treatment literacy and have shown that treatment literacy is fairly high.”

A list of all the ART centres in Nelson Mandela Bay

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