open-ended interviews with 41 individuals living with HIV

open-ended interviews with 41 individuals living with HIV and attending a clinic in Mbarara, Uganda, to understand structural barriers to antiretroviral adherence and clinical care. Almost all respondents cited the need to locate funds for the monthly clinic visit as a constant source of stress and anxiety, and lack of money for transportation was a key factor in cases of missed doses and missed medical appointments. Participants struggled with competing demands between transport costs and other necessities such as food, housing and school fees. These findings suggest that transportation costs can compromise both antiretroviral adherence and access to care. Interventions that address this barrier will be important to ensure the success of antiretroviral programs in sub-Saharan Africa.

Editors' note: With mean per capita income in Uganda the equivalent of 25 USD per month and monthly refill visit roundtrip transport costs ranging from 0.60 to 11.75 USD, it is not surprising that serious sacrifices by patients are required in other essential arenas such as food and school fees. These findings suggest that the concept of ‘access to medicine or lack thereof’ rather than the concept of ‘failure to adhere’, reframes the problem of missed doses as one anchored in structural and financial barriers that need to be addressed by treatment programmes and communities. Many ideas come to mind for piloting such as decentralisation to deliver drugs directly to the community through drug dispensaries, primary care clinics, and home-based care, along with transport cost subsidization for those being stabilised on their regimens and for subsequent 6 monthly control visits.