African Journal of AIDS and HIV Research

African Journal of AIDS and HIV Research ISSN 2326-2691 Vol. 5 (5), pp. 255-264, May, 2017. © International Scholars Journals

Full Length Research Paper

Criteria used for selecting patients for antiretroviral therapy in Uganda: A qualitative study     

Lydia Kapiriri1*, Neema Sofaer2, Lynn M. Atuyambe3, Erasmus Otolok-Tanga3 and Ole Frithjof Norheim4

1Department of Health Aging and Society, McMaster University, Hamilton, ON, Canada L8S 4L8.

2Department of Primary Care and Social Medicine, Faculty of Medicine, Imperial College London.

3Makerere University School of Public Health, Department of Community Health and Behavioural Sciences, Uganda.

4Division for Medical Ethics, Institute of Public Health and the Centre for International Health, University of Bergen, Norway.

*Corresponding author. E-mail: kapirir@mcmaster.ca. Tel: 1 905 525 9140 (27203). Fax: (905) 529-2152.

Accepted 08 July, 2009

Abstract

Limited resources in low income countries still prevent HIV patients from accessing treatment and necessitate the rationing of anti retroviral therapy. This paper aims to describe the criteria used in actual patient selection so as to develop evidence based recommendations for improving fairness in patient selection in Uganda and similar contexts. Qualitative interviews (n = 37) from six AIDS treatment units in Uganda; review of policy and clinic documents; and group discussions (n = 47) people living with AIDS. Practitioners identified both medical criteria (need, CD4 count, WHO staging, Absence of severe co-infections, patient readiness, and ART naivety) and social criteria (economic status, social support, treatment buddy, disclosure, duration with organization, distance, alcohol consumption, relatives of clients on ART, first-in- first- out, vulnerability and activism). There was congruence around the medical criteria across institutions and the national guidelines; and variations around the social criteria. The variations around the social criteria necessitate more explicit debate. Commonly used and accepted criteria could be considered for explicit inclusion in the national guidelines. Disputed criteria should be debated to identify an acceptable set of criteria for ART rationing. These criteria should be publicized to facilitate on-going revisions, ensure consistency, and contribute to fair patient selection.

Key words: HIV/AIDS, anti-retroviral treatment, Uganda, rationing, criteria.