Christy Hansen

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Information about Christy Hansen

Published on December 31, 2007

Author: Felipe


Treatment adherence and stigma:  Treatment adherence and stigma Issues and approaches to address Christy Hanson, PhD, MPH Key Lessons from the XV International Conference on HIV/AIDS, 2004:  Key Lessons from the XV International Conference on HIV/AIDS, 2004 AIDS and TB related stigma remains a major barrier to prevention and treatment Comprehensive, community-based prevention is effective Priority for controlling TB among PLWHA Treatment adherence: the history of TB applicable to ART?:  Treatment adherence: the history of TB applicable to ART? TB treatment: long-term (6-8 months) Periodic exchange between labs and treatment providers Historically: “can’t standardize”, “can’t do outpatient”, “can’t introduce without laboratory back-up” Treatment success under DOTS: >80% Treatment adherence challenges: TB perspective:  Treatment adherence challenges: TB perspective 15-20% that don’t reach cure Co-morbidity, mortality, marginalized? >50% unknown disease outcomes Not registered under DOTS PT not scaled-up, adherence issues DOT: sustainable model considering magnitude of ARTs needed? Stigma: complexities:  Stigma: complexities Marriage of TB/HIV: Desired? Uganda: social support for HIV/AIDS makes it a benefit for TB Kenya: “one disease” mentality limits treatment seeking but stimulates treatment adherence Will this change with availability of ARTs? Ukraine: health workers don’t want to manage HIV; extending to TB Stigma: defining :  Stigma: defining What does stigma look like? How can we identify, measure, monitor? E.g. Kenya: sharing a plate What is the reach? E.g. within communities but not within families Providers Global lessons learned:  Global lessons learned Know the population: not one size fits all Between countries; within countries Build the evidence-base Respond to the evidence What are beliefs, perceptions What constrains / promotes adherence What is the magnitude of stigma What is the role of stigma in limiting adherence Population segmentation:  Population segmentation Youth Marginalized Poor Homeless Illiterate Well-educated Kenya: building evidence:  Kenya: building evidence Household surveys: ~ 450 Family as key force in diagnosis and treatment adherence Families “own” TB problem more than patient Stigma: important factor but complex Positive role of youth as advocates within families YOUTH FOCUS: Joint TB/HIV programming Youth murals: Kenya:  Youth murals: Kenya Theatre Mural art Written essays 3 NGOs Community leaders Schools Nuru Comic Book Series:  Nuru Comic Book Series Promoting healthy lifestyles Decision-making in relationships Incorporating TB/HIV messages Targeting youth Magnet Theatre, IMPACT (Kenya) :  Magnet Theatre, IMPACT (Kenya) Entertaining and engaging theater that encourages self-reflection about personal risk and sustains behavior change. Experiences also “magnified” on radio. Focus on the poor :  Focus on the poor TB commonly known as disease of the poor Changing demographic with HIV Special focus on poor with HIV and TB Equity approach: TB as qualifier for ART Promote equity in ART distribution Treatment adherence issues different for poor Slide14:  Profile of TB patients treated in public and private sectors 3% of patients completing treatment are among the poorest Slide15:  Change in wealth profile along continuum of diagnosis & treatment Urban / rural factors associated with treatment adherence:  Urban / rural factors associated with treatment adherence Nairobi Known / low cost of consultations Informal fees low Cost of medicines Free treatment necessary for adherence Nyeri Distance to facility Cost of transport Wait time at facilities Loss of patients ranking distance as critical factor (6%) Marginalized populations: Ukraine :  Marginalized populations: Ukraine TB and HIV: largely among homeless, drug users and alcoholics Provider stigma Specialized health care system Complicates treatment adherence Ukraine: Stigma reduction:  Ukraine: Stigma reduction Focus on providers Training to communicate with patients Introducing psychosocial support Introduced VCT in ob/gyn clinics Supporting systems Patient referral, shared database (confidential) Ukraine: reducing stigma:  Ukraine: reducing stigma Community information radio, billboards, posters railway stations, pharmacies, cinemas, shops Patient support Initiating peer support groups Legislative: protecting employment Red Cross: food/clothing support, home visits Using retirees as volunteers Cambodia: TB/HIV pilots:  Cambodia: TB/HIV pilots Educating communities Baseline assessments TB/HIV educational flipcharts Radio spots Improving provider-client communications *PATH work to date under FHI pilot project New initiatives:  New initiatives Thailand: operational research with CDC Socio-economic factors associated with co-morbidity and low treatment adherence Tanzania: launch of nationwide TB/HIV Counselor burn-out Human resources for patient support Centralized ART at district-level: adherence issues Conclusions:  Conclusions Magnitude and nature of stigma related to TB/HIV varies by country Role of stigma in treatment adherence varies by country Responses to treatment and low treatment adherence must vary by country EVIDENCE BASED APPROACHES! Thank you :  Thank you

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