Information, motivation, and behavioral skills for early pre-ART engagement in HIV care among patients entering clinical care in KwaZulu-Natal, South Africa

Abstract

Little is known regarding factors implicated in early engagement and retention in HIV-care among individuals not yet eligible for antiretroviral therapy (pre-ART) in sub-Saharan Africa. Identifying such factors is critical for supporting retention in pre-ART clinical care to ensure timely ART initiation and optimize long-term health outcomes. We assessed patients’ pre-ART HIV-care related information, motivation, and behavioral skills among newly diagnosed ART-ineligible patients initiating care in KwaZulu-Natal, South Africa. The survey was interviewer-administered to eligible patients who were 18 years of age or older, newly entering care (diagnosed within the last 6-months), and ineligible for ART (CD4 count >200 cells/mm3) in one of four primary care clinical sites. Self-reported information, motivation and behavioral skills specific to retention in pre-ART HIV-care were characterized by categorizing responses into those reflecting potential strengths and those reflective of potential deficits. Information, motivation, and behavioral skills deficits sufficiently prevalent in the overall sample (i.e., ≥30% prevalent) were identified as areas in need of specific attention through intervention efforts adapted to the clinic level. Gender-based differences were also evaluated. A total of 288 patients (75% female) completed structured interviews. Across the sample, 8 information, 8 motivation, and 8 behavioral skills deficit areas were identified as sufficiently prevalent to warrant specific targeted attention. Gender differences did not emerge. The deficits in pre-ART HIV-care related information, motivation and behavioral skills that were identified suggest that efforts to improve accurate information on immune function and HIV disease are needed, as is accurate information regarding HIV treatment and transmission risk prior to ART initiation. Additional efforts to facilitate the development of social support, including positive interactions with clinic staff and decreasing community-level stigma, and to decrease structural and resource-depleting demands of HIV-care may be particularly valuable to facilitate retention in pre-ART HIV-care.

Retention of antiretroviral naïve patients registered in HIV care in a program clinic in Pune, India

“…A study conducted in South Africa on information, motivation, and behavioral skills for early pre-ART engagement in HIV care identified the critical deficits and strengths and suggested that individuals in pre-ART HIV care may benefit from education and counseling focused on providing more accurate information about pre-ART treatment and infectivity. [15] These authors have suggested that strengthened personal or social motivation can result from individual and/or group opportunities to build positive attitudes, clinic-level intervention to promote more positive interactions with the care team and system of care, and community-level campaigns of continuing efforts to decrease community-level HIV stigma. All these factors would help in better retention of patients.…”

Understanding the acceptability and adherence to paediatric antiretroviral treatment in the new formulation of pellets (LPV/r): the protocol of a realist evaluation

“…It has been applied to various health promotion behaviours, including HIV prevention,35–38 antiretroviral medication adherence39–41 and self-breast examinations 42. It has been validated in resource-rich and resource-limited settings 43–45. While originally developed to predict HIV prevention behaviour, this model can serve as an explanatory framework to explain the caregivers' individual motivation to adhere to the treatment guidelines.…”

“…42 It has been validated in resource-rich and resource-limited settings. [43][44][45] While originally developed to predict HIV prevention behaviour, this model can serve as an explanatory framework to explain the caregivers' individual motivation to adhere to the treatment guidelines. ▸ In a nutshell, the IMB model stipulates that individuals who have correct information, sufficient motivation and behavioural skills will be more likely to achieve good adherence.…”

A Framework for Health Communication Across the HIV Treatment Continuum

“…At the intrapersonal level, ideational barriers to enrolling in care include limited HIV or ART-related knowledge; 73–75 internalized stigma; 73 fear in many forms, including fear of a partner's reaction, 73 fear of potential side effects, 75 fear of losing employment or social status by attending appointments; 75,76 and the negative attitudes and beliefs about ARVs. 72,77–79 Furthermore, feeling healthy or being asymptomatic 72,80–86 and belief in divine healing 81 decrease linkage to care and treatment.…”

“…16,73,75,76,87–90 Before support can be received though, disclosure must occur and disclosure has been found to be a major barrier to ART initiation. 77,82,85,91,92 Disclosure to friends and family enables patients to access the psychosocial and material support crucial for initiating and staying on treatment.…”