Studies Identify Barriers, Solutions in HIV Programs


Closing these gaps in care could improve access for those worse affected by HIV in developing countries.

Two studies from Flinders University have identified several underlying problems faced by HIV programs in African countries, including a lack of nutritional programs for poor patients and inefficient systems that discourage people from using them. Closing these gaps in care could improve access for those worse affected by HIV in developing countries.1

Programs managing HIV in developing countries face many obstacles, including socioeconomic and structural roadblocks. While programs for the broader populations have improved in recent decades, the 2 recent studies from Flinders University focused on the impact of nutritional programs and the treatment of prisoners with HIV.1

The first study, which examined contextual and individual factors influencing nutritional programs, focused on the Tigray region of northern Ethiopia. Addressing malnutrition is a major component of HIV care, and the specific program analyzed was implemented in 2010 across patients in Ethiopia with HIV. Patients were enrolled in the program for 3 months for mild acute malnutrition and for 6 months for severe acute malnutrition.2

The investigators found that of 1757 adult patients, 55.3% recovered from malnutrition, 19% did not complete the program, and 21% completed the program but did not recover from malnutrition. Patients who were living in urban areas, employed, in clinical stages II and III, on antiretroviral therapy (ART) for less than 6 months, and diagnosed with severe acute malnutrition at enrollment were less likely to complete the program.2

These findings led the researchers to conclude that there was a clear link between both contextual factors and individual patient characteristics, and the effectiveness of the program.2

“Taking individual and contextual factors into consideration in program design, planning, and implementation is essential if the nutritional program in HIV care services is to achieve its goal in addressing malnutrition amongst people living with HIV,” the authors wrote.2

The second study focused on the initiation, adherence, and outcomes of ART among incarcerated people, who are at increased risk of HIV compared with the general population. Caring for incarcerated patients with HIV is particularly important because of their frequent movements between prisons and the community, according to the study authors.3

After analyzing 16 quantitative studies, the investigators found that a lack of social support, stigma, discrimination, substance abuse, limited knowledge, and negative perceptions toward ART were the main determinants of suboptimal use of care in incarcerated patients.3

“While correctional facilities often didn’t match community standards of HIV care, we found they could have substantial powers to contribute to the use of HIV treatment as a prevention strategy,” said Terefe Fuge, MD, in a statement.1


  • Major gaps in HIV programs in Africa [news release]. EurekAlert; May 31, 2020. Accessed June 4, 2020.
  • Tesfay F, Ziersch A, Mwanri L, et al. Contextual and individual level factors influencing nutritional program effectiveness in HIV care setting in Tigray region, northern Ethiopia: Mixed methods study. PLOS One; April 27, 2020. Accessed June 4, 2020.
  • Fuge T, Tsourtos G, and Miller E. A systematic review and meta-analyses on initiation, adherence and outcomes of antiretroviral therapy in incarcerated people. PLOS One; May 18, 2020. Accessed June 4, 2020.

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