| Chapter 1: | Introduction |
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established in the 1990s. One of these centers belongs to an organization that has grown over the years, currently operating 35 centers nationwide that provide HAART to about 35,000 individuals (Mugyenyi et al., 2006). Another center is part of a nongovernmental organization that has also grown in size since its inception, currently operating 11 centers around the nation with a total enrollment of approximately 63,000 clients, of which about 14,000 were on HAART in 2005 (TASO, 2002). Increasing access to HAART in Uganda generates interest in studying its effects on those under therapy.
Significance of the Study
The investigation of HAART adherence behavior and its effect on those under therapy in Uganda is important, especially because provision of HAART in low-income nations—such as those in sub-Saharan Africa, where many of the affected individuals are poverty stricken and possess little or no formal education—may result in negative public health implications, including those resulting from suboptimal adherence, such as drug resistance. That is, although long-term effects are still unknown, it is well documented that since its introduction in the mid-1990s, HAART has enhanced the quality of life for those individuals who adhere to treatment regimens (Wilson et al., 2002). However, some studies reveal that poor medication adherence may lead to progression of the disease and enhance its severity (Berg, Michelson, & Safren, 2007). For example, Altice, Maru, Bruce, Springer, and Friedland (2007) found that drug users in the United States have not had favorable outcomes from HAART partially as a result of poor adherence.
Some of the reasons individuals fail to adhere to medication regimens may be because prescription drugs are costly and individuals may be required to take medications on a full stomach. This raises concerns because most individuals in low-income nations live below the international poverty line and may not be able to afford food. For example, it is estimated that 852 million individuals around the world suffer from chronic hunger, of which 843 million live in developing nations where