Bajunirwe Francis, Ayebazibwe Nicholas, Mulogo Edgar, Eng Maria, McGrath Janet, Kaawa-Mafigiri David, Mugyenyi Peter, Sethi Ajay K
Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda.
Applied Science for Health, LLC, Baltimore, MD, USA.
AIDS Care. 2020 Sep;32(9):1111-1115. doi: 10.1080/09540121.2020.1753006. Epub 2020 Apr 11.
Adherence to antiretroviral therapy (ART) is critical in order to achieve viral suppression. We designed an intervention, Mobile Antiretroviral Therapy and HIV care (MAP-HC) in rural southwestern Uganda aimed to reduce travel distance and hypothesized that MAP-HC would improve ART adherence and rates of viral load suppression. The study was conducted at two district hospitals, among patients who lived >5 km from the hospital. For each hospital, we identified 4 health centers in the catchment area to serve as site for the mobile pharmacy. Each site was visited once a month to provide ART refills and adherence counseling. We measured patient waiting time, adherence and viral load suppression before and after the intervention. The proportion of patients who missed an ART dose in the last 30 days dropped from 20% to 8.5% at 12 months post-intervention ( = 0.009) and those with detectable viral load dropped from 19.9% to 7.4% ( = 0.001), however, mean waiting time increased from 4.48 to 4.76 h ( = 0.13). Mobile pharmacy intervention in rural Uganda is feasible and resulted in improvement in adherence and viral load suppression. Although it did not reduce patient waiting time at the clinic, we recommend scale-up in rural areas where patients face transportation challenges.
坚持抗逆转录病毒疗法（ART）对于实现病毒抑制至关重要。我们在乌干达西南部农村地区设计了一项干预措施，即移动抗逆转录病毒疗法与艾滋病毒护理（MAP-HC），旨在缩短出行距离，并假设MAP-HC将提高ART依从性和病毒载量抑制率。该研究在两家地区医院对居住在距离医院超过5公里的患者中进行。对于每家医院，我们在集水区确定了4个卫生中心作为移动药房的地点。每个地点每月访问一次，以提供ART药物补充和依从性咨询。我们在干预前后测量了患者的等待时间、依从性和病毒载量抑制情况。干预后12个月，过去30天漏服ART药物剂量的患者比例从20%降至8.5%（P = 0.009），病毒载量可检测的患者比例从19.9%降至7.4%（P = 0.001），然而，平均等待时间从4.48小时增加到4.76小时（P = 0.13）。乌干达农村地区的移动药房干预措施是可行的，并导致依从性和病毒载量抑制情况得到改善。尽管它没有减少患者在诊所的等待时间，但我们建议在患者面临交通挑战的农村地区扩大规模。
