“Dispense antiretrovirals daily!” restructuring the delivery of HIV services to optimize antiretroviral initiation among men in Malawi

Abstract

Background Gender disparities exist in the scale-up and uptake of HIV services with men being disproportionately under-represented in the services. In Eastern and Southern Africa, of the people living with HIV infection, more adult women than men were on treatment highlighting the disparities in HIV services. Delayed initiation of antiretroviral treatment creates a missed opportunity to prevent transmission of HIV while increasing HIV and AIDS-associated morbidity and mortality. The main objective of this study was to assess the strategies that men prefer for Antiretroviral Therapy (ART) initiation in Blantyre, Malawi. Methods This was a qualitative study conducted in 7 Health facilities in Blantyre from January to July 2017. We selected participants following purposive sampling. We conducted 20 in-depth interviews (IDIs) with men of different HIV statuses, 17 interviews with health care workers (HCWs), and 14 focus group discussions (FGDs) among men of varying HIV statuses. We digitally recorded all the data, transcribed verbatim, managed using NVivo, and analysed it thematically. Results Restructuring the delivery of antiretroviral (ARVs) treatment and conduct of ART clinics is key to optimizing early initiation of treatment among heterosexual men in Blantyre. The areas requiring restructuring included: Clinic days by offering ARVs daily; Clinic hours to accommodate schedules of men; Clinic layout and flow that preserves privacy and establishment of male-specific clinics; ARV dispensing procedures where clients receive more pills to last them longer than 3 months. Additionally there is need to improve the packaging of ARVs, invent ARVs with less dosing frequency, and dispense ARVs from the main pharmacy. It was further suggested that the test-and-treat strategy be implemented with fidelity and revising the content in counseling sessions with an emphasis on the benefits of ARVs. Conclusion The success in ART initiation among men will require a restructuring of the current ART services to make them accessible and available for men to initiate treatment. The inclusion of people-centered approaches will ensure that individual preferences are incorporated into the initiation of ARVs. The type, frequency, distribution, and packaging of ARVs should be aligned with other medicines readily available within a health facility to minimize stigma.

“Men Are Scared That Others Will Know and Will Discriminate Against Them So They Would Rather Not Start Treatment.” Perceptions of Heterosexual Men on HIV-Related Stigma in HIV Services in Blantyre, Malawi

“…The main study was “Strategies for Early Access to HIV Services by Heterosexual Men in Blantyre, Malawi Version 5.0, dated 8th April 2019.” COMREC number P/06/18/2430 and the details of the primary study are published. 17 , 18 The aim of the study was to determine the strategies that heterosexual men prefer for scaling up early uptake of HIV Testing and Antiretroviral initiation.…”

“…All audio-recorded interviews were done at the health facility at a private place. The FGDs were divided according to age and interpreted into one FGD with younger men with an age bracket of eighteen to twenty-four (18)(19)(20)(21)(22)(23)(24) years and the other with older men with an age bracket of 25 years and above at each site. This was done in order to promote participation which could have been limited if we had mixed younger and older men in one group.…”

“…The lay out of this hospital since one is able to see who is on the queue waiting to go HIV testing and this makes girls to start thinking that the client is already on ARV's (FGD, Mpemba Health Centre. [18][19][20][21][22][23][24] For example, where they do the testing it is near the road and also near where some women seat when they leave the hospital and they can clearly see what they are with different kit saying look I was tested with that kit but they are testing him with another kit for the second time; people will just conclude that maybe he has been found positive. (FGD,Mpemba Health centre.…”

“…(FGD,Mpemba Health centre. [18][19][20][21][22][23][24] Participants further described how the rooms where HIV services occur have no measure to conceal activities happening in the room let alone visibility of one entering and accessing such services. Some places do not have a conducive environment and even if they do it inside the rooms from outside everyone can see everything that happens in that room and they can notice that the person entering into that room is going there for this reason even at a place where we offer the ART clinic is easily noticeable by people (FGD, Mpemba Health Centre.…”

“…(FGD, South Lunzu Health Centre. [18][19][20][21][22][23][24] There is however a different notion from what participants from public hospitals said to what participants from private hospitals said. Most men expressed satisfaction with the kind of treatment they get from the private facilities.…”