Barriers and facilitators to linkage to care and ART initiation in the setting of high ART coverage in Botswana

Kebaabetswe, Poloko; Manyake, Kutlo; Kadima, Etienne; Auletta-Young, Chloe; Chakalisa, Unoda; Sekoto, Tumalano; Dintwa, Oarabile Makgabana; Mmalane, Mompati; Makhema, Joseph; Lebelonyane, Refeletswe; Bachanas, Pamela; Plank, Rebeca M.; Gaolathe, Tendani; Lockman, Shahin; Holme, Molly Pretorius

doi:10.1080/09540121.2019.1640843

Cited by 19 publications

(15 citation statements)

References 17 publications

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“…It is well-established fact that patients who disclosed their HIV status to treatment supporters (peer groups, family members, and community health workers) are more likely to engage in clinical care and achieve good viral suppression. 18 , 22 , 24 , 26 , 34 , 37 , 39 In agreement to this, in the current study, participants revealed that patients need more time to disclose their status to their family members and treatment supporters. This is supported by a previous study that most of the treatment eligible patients were not ready to start ART in the same-days of diagnosis in Ethiopia.…”

Section: Discussionsupporting

confidence: 85%

“…Our findings confirmed that there was a patient friendly environment in the HIV clinic which is not common among African countries such as Mozambique, Kenya, Uganda and Botswana. 18 , 19 , 39 Therefore, we recommend maintaining this positive patient–provider relationship.…”

Section: Discussionmentioning

confidence: 99%

“…That is supported from previous systematic reviews that men and younger people were at increased risk of poor linkage and loss of follow-up. 12,[37][38][39] Furthermore, couples tested for pre-marital HIV screening were not ready to start ART. This indicated that there is a need for strong pre-test information that includes test result acceptance preparation.…”

Section: Dovepressmentioning

confidence: 99%

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<p>Barriers and Facilitators of Same-Day Antiretroviral Therapy Initiation Among People Newly Diagnosed with HIV in Ethiopia: Qualitative Study Using the Transtheoretical Model of Behavioral Change</p>

Moges¹,

Adesina²,

Okunlola³

et al. 2020

JMDH

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Purpose: HIV test and treat approach is currently a strategy used as a part of the prevention and control program in Ethiopia. The strategy adopts initiating antiretroviral therapy (ART) on the same-day as HIV diagnosis or in the next visit. However, there is little evidence on barriers and facilitators of same-day (ART) initiation in Ethiopia. Therefore, this study aimed to investigate barriers and facilitators of same-day (ART) initiation in the northwest Ethiopia. Patients and Methods: A qualitative study was conducted in East Gojjam Zone in northwest Ethiopia. Purposively selected HIV patients, healthcare workers, and treatment assistants participated in the qualitative study. Data were collected through in-depth interviews and focus group discussions (FGDs). Coding was done via ATLAS.ti software thematically. The interviews and FGDs were conducted in Amharic (local language) and then transcribed verbatim and translated into English. Coding was done via ATLAS.ti software. The thematic analysis approach was employed using the constructs of the transtheoretical behavioral model (TTM) to show stages of change that newly HIV diagnosed experienced in the course of preparation for treatment initiation. Results: A total of 19 patients, 12 treatment supporters, and 9 healthcare workers participated in the qualitative study. Shocking due to the test result, having no symptoms, mistrust of the test result, and seeking spiritual healing from holy water were the major barriers to start ART in the same-day of diagnosis or within the next visit. Conclusion: During HIV diagnosis, more barriers were observed in the early stages, while treatment facilitators emerged in the later stages of TTM. The TTM model can be applied to characterize where participants were in the stages of change.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Dovepressmentioning

confidence: 99%

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<p>Barriers and Facilitators of Same-Day Antiretroviral Therapy Initiation Among People Newly Diagnosed with HIV in Ethiopia: Qualitative Study Using the Transtheoretical Model of Behavioral Change</p>

Moges¹,

Adesina²,

Okunlola³

et al. 2020

JMDH

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show abstract

“…Some promising and good practices that were shared highlighted the importance of a proximity between community-based organizations, health professionals, and persons living with HIV. Some of the promising practices (e.g., first consultation at the same time as, or immediately after, the reactive test; existence of a mediator between the patient and the hospital; regular sharing of information between referral hospitals and the community-based organizations) are in line with what has been reported in the literature as facilitators to ART adherence, such as family/social support, good relationship with the health provider, or perceived health benefits [ 39 , 41 , 42 , 43 ].…”

Section: Discussionsupporting

confidence: 59%

HIV Infection: Time from Diagnosis to Initiation of Antiretroviral Therapy in Portugal, a Multicentric Study

et al. 2021

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The benefits of antiretroviral therapy (ART) for persons living with HIV (PLWH) are well established. Rapid ART initiation can lead to improved clinical outcomes. Portugal has one of the highest rates of new HIV diagnoses in the European Union, and an average time until ART initiation above the recommendations established by the national guideline according to data from the first two years after its implementation in 2015, with no more recent data available after that. This study aimed to evaluate time from the first hospital appointment until ART initiation among newly diagnosed HIV patients in Portugal between 2017 and 2018, to investigate differences between hospitals, and to understand the experience of patient associations in supporting the navigation of PLWH throughout referral and linkage to the therapeutic process. To answer to these objectives, a twofold design was followed: a quantitative approach, with an analysis of records from five Portuguese hospitals, and a qualitative approach, with individual interviews with three representatives of patient associations. Overall, 847 and 840 PLWH initiated ART in 2017 and in 2018, respectively, 21 days (median of the two years) after the first appointment, with nearly half coming outside the mainstream service for hospital referral, and with observed differences between hospitals. In 2017–2018, only 38.0% of PLWH initiated ART in less than 14 days after the first hospital appointment. From the interviews, barriers of administrative and psychosocial nature were identified that may hinder access to ART. Patient associations work to offer a tailored support to patients’ navigation within the health system, which can help to reduce or overcome those potential barriers. Indicators related to time until ART initiation can be used to monitor and improve access to specialized care of PLWH.

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“…Family and community support identified in our study was reported to positively impact linkage to care, which promotes acceptance and thus limits self-stigma. This is in line with the findings of previous studies conducted in Tanzania and Botswana that reported that support from peers and community members were major facilitators in linkage to care for PLHIV peers escorted HIV patients to care points, and the majority of the patients have access to care [ 31 , 41 ].…”

Section: Discussionsupporting

confidence: 90%

Perspectives on linkage to care for patients diagnosed with HIV: A qualitative study at a rural health center in South Western Uganda

et al. 2022

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Linkage to care for newly diagnosed human immunodeficiency virus (HIV) patients is important to ensure that patients have good access to care. However, there is little information about factors influencing linkage to care for HIV patients. We aimed to identify existing measures in place that promote linkage to care and to explore facilitators and barriers to linkage to care for clients diagnosed with HIV/acquired immune deficiency syndrome at a rural health center in Uganda. This descriptive qualitative study enrolled 33 purposively selected participants who included expert clients, linkage facilitators, heads of families with people living with HIV, and health workers. Data were collected using in-depth interviews that were audio-recorded, transcribed, and translated. The data were manually analyzed to generate themes. The following four themes were generated: 1) availability of services that include counseling, testing, treatment, follow-up, referral, outreach activities, and support systems. 2) Barriers to linkage to care were at the individual, health facility, and community levels. Individual-level barriers were socioeconomic status, high transport costs, fear of adverse drug effects, fear of broken relationships, and denial of positive results or treatment, while health facility barriers were reported to be long waiting time, negative staff attitude, and drug stock outs. Community barriers were mostly due to stigma experienced by HIV clients, resulting in discrimination by community members. 3) Facilitators to linkage to care were positive staff attitudes, access to information, fear of death, and support from others. 4) Suggestions for improving service delivery were shortening waiting time, integrating HIV services, increasing staff numbers, and intensifying outreaches. Our findings highlight the importance of stakeholder involvement in linkage to care. Access and linkage to care are positively and negatively influenced at the individual, community, and health facility levels. However, integration of HIV services and intensifying outreaches are key to improving linkage to care.

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Barriers and facilitators to linkage to care and ART initiation in the setting of high ART coverage in Botswana

Cited by 19 publications

References 17 publications

<p>Barriers and Facilitators of Same-Day Antiretroviral Therapy Initiation Among People Newly Diagnosed with HIV in Ethiopia: Qualitative Study Using the Transtheoretical Model of Behavioral Change</p>

<p>Barriers and Facilitators of Same-Day Antiretroviral Therapy Initiation Among People Newly Diagnosed with HIV in Ethiopia: Qualitative Study Using the Transtheoretical Model of Behavioral Change</p>

HIV Infection: Time from Diagnosis to Initiation of Antiretroviral Therapy in Portugal, a Multicentric Study

Perspectives on linkage to care for patients diagnosed with HIV: A qualitative study at a rural health center in South Western Uganda

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