Is forced displacement a barrier to acceptable outcomes among refugees on antiretroviral therapy? : a field-study in Malaysia and Kenya

In response to a major gap in evidence regarding treatment outcomes among asylum-based refugees. the primary objective of the thesis was to investigate adherence to highly active antiretroviral therapy (HAART) and virological outcomes among refugees and to compare these outcomes with local host communities in one urban, Southeast Asia setting (Sungai Buloh, Kuala Lumpur, Malaysia) and one remote sub-Saharan refugee camp (Kakuma. Kenya) setting. Given limited resources for expanding treatment, questions have been raised as to whether refugees can achieve sufficient levels of adherence and viral suppression to justify sustaining and expanding access. Data sources included a structured questionnaire with self-reported adherence measures, a pharmacy-based prescription refill measure, HIV viral loads, and indepth interviews. Analyses made use of quantitative and qualitative approaches. The thesis begins by presenting the rationale, aims, research questions, and a description of preparatory work. Paper One presents the results of a systematic review of the literature on adherence to HAART and treatment outcomes among conflict-affected and forcibly displaced populations. finding only 17 reports, five of which included less than