A three-month campaign by Addis Ababa's health bureau hopes to boost adherence to antiretroviral (ARVs) drugs in the Ethiopian capital by improving communication between patients and health service providers.
A 2009 study by the HIV/AIDS Prevention and Control Office found that on average, 72.3 percent of patients on ARVs were still on first-line medication one year after starting treatment.
"The remaining are lost... it could be due to any number of reasons such as death or an unannounced change of location but it is a cause for concern," said Addis Akalu, head of the disease prevention and control department at the Addis Ababa Health Bureau.
According to Esmael Wabela, HIV prevention and treatment adviser at the city's heath bureau, insufficient food, high transport costs to drug collection points and stigma-related issues such as fear of disclosure are some of the main reasons HIV-positive Ethiopians fail to stick to ARVs.
Such failure can hasten progress from HIV to AIDS; patients taking their drugs irregularly also run the risk of developing drug resistant strains of the virus, requiring significantly more costly second- and third-line ARVs.
Addis Ababa's health bureau is partnering with the national AIDS Resource Centre (ARC) on the three-month campaign, launched in March and funded by the US President's Emergency Plan for AIDS Relief. Through a mass-media campaign and the use of toll-free telephone HIV/AIDS information services, it seeks to promote "astewai" (responsible patients), and "tagash" (tolerant service providers) as part of its efforts to improve adherence.
"There are findings to suggest that if there is good communication between clients and service providers, better services are provided," said Anthoula Assimacopoulou, ART communication programme officer at the ARC.
Some 26 state-run health centre, five state-run hospitals and 13 private facilities that provide ART in Addis Ababa will participate in the campaign, with a plan to roll it out to the rest of the country should it prove successful.
"For our communication campaign, we took best practices from Indonesia. The  campaign they did there was called 'Smart'; it aimed to improve the effective use of family planning services targeting clients," Anthoula added. "What we did here in Addis is we targeted both clients and service providers because we found that both need help in their work."
According to Anthoula, most clients visiting health centres in Ethiopia are timid. "They are typically non-assertive as when they go to health providers they don't ask questions and they are shy to express themselves and talk about their health status."
A 10-minute campaign video encourages patients to keep a note book and jot down issues to discuss during consultations with health workers; the video also encourages patients to lead healthy lifestyles and protect others from the virus.
"I am sure this [campaign] will help but some of the challenges we face are more to do with the health facility," said one client, who requested anonymity. "As you see here, there is only one room and three clients are in with their service providers at the same time... this obviously makes things a bit harder for one-to-one conversation and that ideal environment to have an in-depth discussion about one's health and feelings."
Thomas Ayele, a city health worker, says he and his colleagues often see as many as 30 patients every day; assessments done by the campaign found health workers to be overburdened.
"We don't have a burnout management system that helps professionals cope with a tense working environment they could face. This was a major problem for our doctors in the pre-ART period as more than 40 percent of the hospital beds were occupied by people living with HIV and the doctors felt helpless to do anything for them and most left the service subsequently," said Esmael.
|When [patients] go to health providers, they don't ask questions and they are shy to express themselves and talk about their health status|
However, officials say the weaknesses in the health system are being addressed and improved.
"When the ART service was first launched, it was only in hospitals but the demand was so huge that health centres soon followed and now even in private hospitals ART is given for free; soon, with the completion of health centres under construction and commencement of the service by NGO clinics that are applying to provide the service, it will improve significantly," said Addis.
According to Esmael, the campaign could serve as the basis for the creation of a burnout management system.
Some of the skills being imparted to health professionals include time management, better interpersonal communication skills and body language, the importance of working with clients and the use of appropriate language.
Health workers like Thomas, who say clients get upset when health workers are unable to help with requests for food assistance, will also now have information to provide clients with referrals to non-medical HIV services.