Dr. Marguerite Thorp recently published an assessment of access to HIV treatment in Malawi in the Journal of the International AIDS Society (JIAS). This study was supported by CHIPTS global seed funds. To access the publication, click here. Learn more about Dr. Thorpe’s work below.
Malawi’s robust national HIV treatment program offers free antiretroviral treatment for nearly one million people living with HIV. Though the program has delivered success for many, UCLA faculty members Dr. Thomas Coates (Global HIV Co-Director, CHIPTS Administrative Core) and Dr. Kathryn Dovel work with Partners in Hope, a medical and research organization based in Lilongwe, Malawi, to study vulnerable groups who continue to face barriers to care. The recent publication, led by GloCal Health postdoctoral fellow Dr. Marguerite Thorp, focused on highly mobile men enrolled in two parent trials led by Dr. Coates and Dr. Dovel.
“Mobility is essential for many people in Malawi – to find work, to care for family members, and to buy and sell goods,” Dr. Thorp said. “Men living with HIV have the same need to travel – maybe even more so – but mobility makes it difficult to access treatment.”
The study combined survey data from participants in the parent trials and in-depth interviews with mobile men. Researchers found that, although mobility was crucial for men to support their families, it often conflicted with accessing care for HIV. Men often had less than a day to prepare for a trip that may last weeks or months, but felt they had no choice but to accept such unpredictable work arrangements.
As a result, mobile men missed appointments to refill their antiretroviral medications, and returning to care after a missed appointment was difficult. Survey data showed that men who spent more time away from home in the year before trial enrollment also had longer interruptions in their HIV treatment. Researchers highlighted problems with the health system – from inflexible appointment scheduling to restrictions on when and where men can refill medications to unwelcoming providers – that worsened the conflict between mobility and HIV care.
Dr. Thorp and her colleague Kelvin Balakasi, Junior Data Scientist at Partners in Hope, are now leading a subsequent study supported by a CHIPTS pilot grant and UCLA’s Center for AIDS Research. They will design and test a screening tool to identify people living with HIV that may be at risk of stopping treatment due to mobility or other risk factors, including alcohol use and depression. The researchers hope to eventually study interventions that can reduce the risk of treatment interruption for vulnerable people living with HIV.