Science Shop project's: Inspiring Stories

Science Shop project's: Inspiring Stories

Engaging civil society in HIV treatment adherence in Tunisia

First steps to build a participatory action research against stigmatization in health care environments

By Nadia Ben Manssour

Since 1980, the number of newly reported HIV infections had doubled in several regions of the world. At the same time, recent advances in biological sciences and clinical research had successfully improved screening, virological monitoring and treatment efficiency of HIV. Thanks to Anti-Retroviral Therapy (ART), the survival and the life quality of people living with HIV had greatly improved. In fact, countries adopting the ART therapy had shown the lowest HIV-related morbidity and mortality rates.

Nevertheless, high levels of adherence to ART (at least 95%) are needed to keep an undetectable viral load and to ensure optimal benefits for the patient. It is also important to insure better clinical outcomes as well as preventing sexual transmission to negative HIV persons.

In Tunisia, despite the country policy against HIV infection, the rate of new cases increases to 12% between 2010 and 2017. Hence, it’s crucial to ensure an appropriate and better management of HIV patients quantitatively and qualitatively by providing and ensuring the adherence to the treatment (more than 95%). This fact aligns with the alarming current situation of persons living with HIV (PLHIV), characterized by the emergence of drug resistance and the deterioration of PLHIV health status. It should be emphasized that several reports have been published about HIV/ AIDS care, but none was published on implementing interventions to enhance PLHIV adherence.

Within the framework of the call launched by Science Shop “Science together” to collect social needs, ATP+ (Association Tunisienne de Prévention Positive), an association involved in promoting better care for persons living with HIV, submitted the need to communicate experiences of PLHIV with health care support in Tunisia. ATP+ co-created the project with researchers from different scientific backgrounds (doctor, epidemiologist, sociologist) from different institutions: Institut Pasteur de Tunis, National Public Health Institute and Tunis Institute of Human Sciences. This work was first approved by the biomedical ethics committee of Institut Pasteur de Tunis (IRB) after the elaboration of related informed-consent forms for all the project participants.

An original research design was performed based on reformulation of the ATP+ request, in order to inform about factors behind non-adherence to treatment among PLVIH. The overall aim of this Science Shop project is to improve future intervention designs applicable at the health structure level.

The study consists on the design of qualitative original research through interviewing PLHIV and stakeholders (health care workers, program manager at the Ministry of Health, international organizations, etc.) from different perspectives in order to compare points of views and highlight the contradictions and agreements. In depth interviews with 10 PLHIV who benefit of ATP+ services, as well as semi-structured interviews with 10 stakeholders were planned. The interpretation of the different points of views will be helpful to ensure a global vision of the assessment, as well as the applicability of the recommendations. During eight months, a master student was selected and trained to perform, transcript and analyze the interviews with the assistance of the ATP+ team. Preliminary results and the process assessment of this collaboration will be communicated in February 2020 to the public and policy makers.