‘Good health’ as a barrier and facilitator to ART initiation: a qualitative study in the era of test-and-treat in Mozambique

Magaço, Amílcar; Dovel, Kathryn; Cataldo, Fabian; Nhassengo, Pedroso; Hoffman, Risa M.; Nerua, Lucas; Tique, José A.; Saide, Mohomed; Couto, Aleny; Mbofana, Francisco; Gudo, Eduardo Samo; Cuco, Rosa Marlene; Chicumbe, Sérgio

doi:10.1080/13691058.2018.1535091

Cited by 10 publications

(8 citation statements)

References 23 publications

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“…For this success to translate into long-term viral suppression, consistent retention in HIV care is essential. Yet successfully engaging in HIV care over time is complicated—involving frequent visits to the health facility and daily ART adherence amidst other life priorities and familial demands [ 2 , 3 ]. These challenges are reflected in high rates of default from ART programs in sub-Saharan Africa over time [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

How HIV Clients Find Their Way Back to the ART Clinic: A Qualitative Study of Disengagement and Re-engagement with HIV Care in Malawi

Chamberlin

Mphande²,

Phiri³

et al. 2021

AIDS Behav

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Retention in antiretroviral therapy (ART) services is critical to achieving positive health outcomes for individuals living with HIV, but accumulating evidence indicates that individuals are likely to miss ART appointments over time. Thus, it is important to understand why individuals miss appointments and how they re-engage in HIV care. We used in-depth interviews with 44 ART clients in Malawi who recently missed an ART appointment (> 14 days) but eventually re-engaged in care (within 60 days) to explore reasons for missed appointments and barriers and facilitators to re-engagement. We found that most individuals missed ART appointments due to unexpected life events such as funerals, work, and illness for both clients and their treatment guardians who were also unable to attend facilities. Several reasons differed by gender—work-related travel was common for men, while caring for sick family members was common for women. Barriers to re-engagement included continued travel, illness, and restricted clinic schedules and/or staff shortages that led to repeat facility visits before being able to re-engage in care. Strong internal motivation combined with social support and reminders from community health workers facilitated re-engagement in HIV care.

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Section: Introductionmentioning

confidence: 99%

How HIV Clients Find Their Way Back to the ART Clinic: A Qualitative Study of Disengagement and Re-engagement with HIV Care in Malawi

Chamberlin

Mphande²,

Phiri³

et al. 2021

AIDS Behav

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“…In mission hospitals of Zimbabwe (2017), retention at three months was as high as 90% 15 . Good health (at diagnosis) has been reported to act both as a barrier as well as a facilitator to ART initiation 17 , 18 , therefore, we speculate that good health at ART initiation may also act both as a barrier as well as a facilitator to ART retention. Another potential reason for the observed lower retention could be deficiencies in coverage of quality adherence counselling with likely increased work load during the “Treat All” era.…”

Section: Discussionmentioning

confidence: 80%

Anti-retroviral therapy after “Treat All” in Harare, Zimbabwe: What are the changes in uptake, time to initiation and retention?

Matare

Shewade

Ncube³

et al. 2020

F1000Res

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Background: In Zimbabwe, Harare was the first province to implement “Treat All” for people living with human immunodeficiency virus (PLHIV). Since its roll out in July 2016, no study has been conducted to assess the changes in key programme indicators. We compared antiretroviral therapy (ART) uptake, time to ART initiation from diagnosis, and retention before and during “Treat All”. Methods: We conducted an ecological study to assess ART uptake among all PLHIV newly diagnosed before and during “Treat All”. We conducted a cohort study to assess time to ART initiation and retention in care among all PLHIV newly initiated on ART from all electronic patient management system-supported sites (n=50) before and during “Treat All”. Results: ART uptake increased from 65% (n=4619) by the end of quarter one, 2014 to 85% (n=5152) by the end of quarter four, 2018. A cohort of 2289 PLHIV was newly initiated on ART before (April-June 2015) and 1682 during “Treat all” (April-June 2017). Their age and gender distribution was similar. The proportion of PLHIV in early stages of disease was significantly higher during “Treat all” (73.2% vs. 55.6%, p<0.001). The median time to ART initiation was significantly lower during “Treat All” (31 vs. 88 days, p<0.001). Cumulative retention at three, six and 12 months was consistently lower during “Treat all” and was significant at six months (74.9% vs.78.1% p=0.022). Conclusion: Although there were benefits of early ART initiation during “Treat All”, the programme should consider strategies to improve retention.

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“…For instance, in South Africa 18 and Haiti, 17 35% and 20% of same-day initiators did not return to refill their ART after the initial ART dispensation, respectively, resulting in a phenomenon of “failed initiation” that program managers need to explore to understand and find resolutions for. Additionally, previous studies have showed that fear of drug side effects, inadvertent HIV status disclosure and discrimination 38 are few of the items that need to be addressed prior to ART initiation to ensure good ART adherence.…”

Section: Discussionmentioning

confidence: 99%

Adherence to Antiretroviral Treatment Among People Who Started Treatment on the Same-Day of HIV Diagnosis in Ethiopia: A Multicenter Observational Study

Ahmed¹,

Demissie²,

Worku³

et al. 2021

HIV

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‘Good health’ as a barrier and facilitator to ART initiation: a qualitative study in the era of test-and-treat in Mozambique

Cited by 10 publications

References 23 publications

How HIV Clients Find Their Way Back to the ART Clinic: A Qualitative Study of Disengagement and Re-engagement with HIV Care in Malawi

How HIV Clients Find Their Way Back to the ART Clinic: A Qualitative Study of Disengagement and Re-engagement with HIV Care in Malawi

Anti-retroviral therapy after “Treat All” in Harare, Zimbabwe: What are the changes in uptake, time to initiation and retention?

Adherence to Antiretroviral Treatment Among People Who Started Treatment on the Same-Day of HIV Diagnosis in Ethiopia: A Multicenter Observational Study

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