Where are we now? A multicountry qualitative study to explore access to pre-antiretroviral care services: a precursor to antiretroviral therapy initiation
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Date
2017
Journal Title
Journal ISSN
Volume Title
Publisher
Sexually transmitted infections
Abstract
To explore barriers and facilitators to
accessing postdiagnosis HIV care in five sub-Saharan
African countries.
Methods In-depth interviews were conducted with
77 people living with HIV (PLHIV) in pre-antiretroviral
therapy care or not-yet-in care and 46 healthcare
workers. Participants were purposely selected from health
and demographic surveillance sites in Karonga (Malawi),
Manicaland (Zimbabwe), uMkhanyakude (South Africa),
Kisesa (Tanzania) and Rakai and Kyamulibwa (Uganda).
Thematic content analysis was conducted, guided by the
constructs of affordability, availability and acceptability
of care.-
Results Affordability: Transport and treatment costs
were a barrier to HIV care, although some participants
travelled to distant clinics to avoid being seen by
people who knew them or for specific services. Broken
equipment and drug stock-outs in local clinics could also
necessitate travel to other facilities. Availability: Some
facilities did not offer full HIV care, or only offered all
services intermittently. PLHIV who frequently travelled
complained that care was seldom available to them
in places they visited. Acceptability: Severe pain or
sickness was a key driver for accessing postdiagnosis
care, whereas asymptomatic PLHIV often delayed
care-seeking. A belief in witchcraft was a deterrent to
accessing clinical care following diagnosis. Changing
antiretroviral therapy guidelines generated uncertainty
among PLHIV about when to start treatment and delayed
postdiagnosis care. PLHIV reported that healthcare
workers’ knowledge, attitudes and behaviours, and
their ability to impart health education, also influenced
whether they accessed HIV care.
Conclusion Despite efforts to decentralise services
over the past decade, many barriers to accessing HIV
care persist. There is a need to increase sustained access
to care for PLHIV not yet on treatment, with initiatives
that encompass biomedical aspects of care alongside
considerations for individual and collective challenges
they faced. A failure to do so may undermine efforts to
achieve universal access to antiretroviral therapy.
Description
Keywords
Multicountry qualitative study, Pre-antiretroviral care services, Antiretroviral therapy initiation
Citation
Bukenya, D., Wringe, A., Moshabela, M., Skovdal, M., Ssekubugu, R., Paparini, S., ... & Seeley, J. (2017). Where are we now? A multicountry qualitative study to explore access to pre-antiretroviral care services: a precursor to antiretroviral therapy initiation. Sexually transmitted infections, 93(Suppl 3). doi:10.1136/ sextrans-2016-052970