Conflict and Health
Volume 12, Issue 1, 2018

A qualitative approach to understand antiretroviral therapy (ART) adherence for refugees living in Nakivale Refugee Settlement in Uganda (Article) (Open Access)

O'Laughlin K.N.* , Rouhani S.A. , Kasozi J. , Greenwald K.E. , Perkons N.R. , Faustin Z.M. , Bassett I.V. , Ware N.C.
  • a Division of International Emergency Medicine and Humanitarian Programs, Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, United States, Medical Practice Evaluation Center, Department of Internal Medicine, Massachusetts General Hospital, 100 Cambridge Street, Boston, MA 02114, United States, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, United States
  • b Division of International Emergency Medicine and Humanitarian Programs, Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, United States, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, United States
  • c United Nations High Commissioner for Refugees, P.O. Box 3813, Kampala, Uganda
  • d Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, United States, Harvard Affiliated Emergency Medicine Residency, 75 Francis Street, Boston, MA 02115, United States
  • e Harvard University, Massachusetts Hall, Boston, MA 02138, United States
  • f Bugema University, P.O. Box 6529, Kampala, Uganda
  • g Medical Practice Evaluation Center, Department of Internal Medicine, Massachusetts General Hospital, 100 Cambridge Street, Boston, MA 02114, United States, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, United States, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, United States, Harvard University Center for AIDS Research, 42 Church Street, Cambridge, MA 0213, United States
  • h Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, United States, Department of Global Health and Social Medicine, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, United States

Abstract

Background: Refugees living with HIV in sub-Saharan Africa suffer unique hardships that may increase their vulnerability to interruptions in antiretroviral therapy (ART). Methods: To investigate refugees' experiences adhering to ART, we conducted inperson interviews with refugees on ART (n = 73) and HIV clinic staff (n = 4) in Nakivale Refugee Settlement in southwest Uganda from March to July 2011. Three analysts used a conventional content analysis approach to evaluate these data. Results: Refugees described profound motivation to adhere to ART and employed adherence strategies to facilitate success despite the austere setting. However, refugees spoke of specific hardships living in Nakivale that served as barriers to ART adherence, including difficulty accessing clinic when ill, food insecurity, drug stockouts, and violence and unrest in the settlement. For some refugees, need for ART inextricably linked them to the HIV clinic and prevented them from transitioning permanently away from the settlement. Conclusions: By learning about refugees' experiences we can design informed interventions to enhance ART adherence, thus minimizing morbidity and mortality, preventing transmission of HIV, and supporting refugees' abilities to move freely toward repatriation, resettlement or integration in their host country. © 2018 The Author(s).

Author Keywords

Sub-Saharan Africa Migration Art ART adherence AIDS Antiretroviral therapy Uganda HIV Refugee Africa

Index Keywords

[No Keywords available]
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85043521623&doi=10.1186%2fs13031-018-0145-1&partnerID=40&md5=68f2aba900c8dd7073862009b22b902c
DOI: 10.1186/s13031-018-0145-1
ISSN: 17521505
Cited by: 1
Original Language: English