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Health Education Research Advance Access published online on June 9, 2005
Health Education Research, doi:10.1093/her/cyh039
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© The Author 2005. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oupjournals.org
Received October 24, 2004
Accepted May 11, 2005

Original article

Improving adherence to highly active anti-retroviral therapy in Africa: the DREAM programme in Mozambique

M. C. Marazzi 1, M. Bartolo 2, L. Emberti Gialloreti 3, P. Germano 2, G. Guidotti 4, G. Liotta 3, M. Magnano San Lio 2*, S. Mancinelli 3, M. A. Modolo 5, P. Narciso 6, C. F. Perno 7, P. Scarcella 3, G. Tintisona 2, and L. Palombi 3

1 LUMSA University, 00193 Rome, Italy
2 Community of Sant'Egidio, DREAM Programme, 00153 Rome, Italy
3 Department of Public Health, Hygiene, Tor Vergata University, 00133 Rome, Italy
4 Italian National Institute of Health, 00161 Rome, Italy
5 Center for Health Education, University of Perugia, 06100 Perugia, Italy
6 National Institute of Infectious Diseases ‘L. Spallanzani’, 00149 Rome, Italy
7 Department of Experimental Medicine and Biology Science, Microbiology, Tor Vergata University, 00133 Rome, Italy

* To whom correspondence should be addressed.
M. Magnano San Lio, E-mail: massimo.magnano{at}aliceposta.it


  Abstract

Ensuring high levels of adherence to highly active anti-retroviral therapy (HAART) is a priority in treating people living with AIDS. This study reports the rates of adherence of patients served by DREAM (Drug Resource Enhancement against AIDS and Malnutrition) in the city of Matola, Mozambique. DREAM, an innovative programme tailored for Africa, was implemented by the Community of Sant'Egidio in August 2001. DREAM provides patients with anti-retroviral drugs and laboratory tests at no charge, and is based on a particular strategy of health education and organization of services designed for a population that is predominantly poor and has a low level of formal education. This study analyzes the adherence of 154 patients over a period of 6 months. In evaluating adherence, two indicators were used: (1) the percentage of appointments kept for check-ups, tests and the collection of medicine, and (2) the overall change in the patients' blood chemistry over the 6-month period. Of the 154 patients, 127 (82.5%) kept more than 90% of their appointments. Adherence to the programme was further confirmed by a relevant increase of hemoglobin levels and CD4 counts, and a significant decrease in the viral loads among the 154 patients.


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