Patient Selection Criteria for Antiretroviral Therapy in Uganda: Insights from a Qualitative Study

Abstract

Limited resources in low income countries still prevent HIV patients from accessing treatment and necessitate the 
rationing of anti retroviral therapy. This paper aims to describe the criteria used in actual patient selection so as to 
develop evidence based recommendations for improving fairness in patient selection in Uganda and similar 
contexts. Qualitative interviews (n = 37) from six AIDS treatment units in Uganda; review of policy and clinic 
documents; and group discussions (n = 47) people living with AIDS. Practitioners identified both medical criteria 
(need, CD4 count, WHO staging, Absence of severe co-infections, patient readiness, and ART naivety) and social 
criteria (economic status, social support, treatment buddy, disclosure, duration with organization, distance, 
alcohol consumption, relatives of clients on ART, first-in- first- out, vulnerability and activism). There was 
congruence around the medical criteria across institutions and the national guidelines; and variations around the 
social criteria. The variations around the social criteria necessitate more explicit debate. Commonly used and 
accepted criteria could be considered for explicit inclusion in the national guidelines. Disputed criteria should be 
debated to identify an acceptable set of criteria for ART rationing. These criteria should be publicized to facilitate 
on-going revisions, ensure consistency, and contribute to fair patient selection.