Barriers to Access to Antiretroviral Treatment in Mozambique as Perceived by Patients and Health Workers in Urban and Rural Settings

Presenter: Mariana Posse, Radboud University Nijmegen Medical Centre

Abstract

Background: The introduction of antiretroviral treatment (ART) has made what was once a terminal illness into a treatable chronic condition. However, in low and middle income countries this new picture is not yet a reality for about 70% in a universe of 9.7 million of people estimated to be in need of ARVs but who do not access it. Amongst these countries, Mozambique is amongst those with enormous numerical need for ART coverage, with 280 000 patients clinically eligible to receive ART of which less than 30% were receiving it up to the end of 2007. This paper aims to identify and compare the factors impeding HIV/AIDS patients from accessing ART in urban and rural settings in Mozambique.

Methods and findings: The study population consisted of people living with HIV/AIDS (252) and health workers (28). Data was collected on the basis of FGDs and interviews with people living with HIV/AIDS and with health workers. The analysis was performed using content analysis, factor analysis and percentages of the maximum attainable scores.

Patients and health workers were positive about patient information and attitudes towards treatment (74%), health personnel confidentiality (79%), and family support (77%). They were less positive about service availability (53%), rating negatively the waiting time to receive the results of CD4 analysis (45%) and the sufficiency of doctors/nurses at the health facility (45%). They were negative about community information (47%) and even more so about patient resource availability, which they rated below 40% of the maximum attainable score.

Conclusion: Barriers to access to ART are consistent across urban and rural settings in Mozambique. Policy makers, in efforts to further improve the access to ART may decide to target their attention in designing interventions to improve specific aspects on patient resource availability, community information and service availability. In addition, our findings suggest that these recommendations hold for both urban and rural settings in Mozambique.