Adherence to combination antiretroviral therapy in complex emergency settings
Adherence can be high, with contingency plans and dedicated resources
In 2006, about 1.8 million people with HIV had been affected by conflict, disaster, or displacement.1 People living within these often transient and volatile settings are vulnerable to violence, poverty, and natural disaster, all of which make consistent management of HIV a challenge. In a recent prospective cohort study in the BMJ, Kiboneka and colleagues describe their experiences in providing combination antiretroviral therapy to a large cohort of HIV infected patients from a camp for internally displaced people in northern Uganda.2 The study shows how some of the barriers to treating people infected with HIV in conflict settings can be overcome.
Before the initial scale up of combination antiretroviral therapy in sub-Saharan Africa, policy makers from industrialised countries expressed concerns and scepticism about the feasibility of providing this treatment in resource poor settings. Factors associated with poverty, including lack of education and access to care, were thought to be insurmountable