Multi-Level Factors Affecting Entry into and Engagement in the HIV Continuum of Care in Iringa, Tanzania

Abstract

Progression through the HIV continuum of care, from HIV testing to lifelong retention in antiretroviral therapy (ART) care and treatment programs, is critical to the success of HIV treatment and prevention efforts. However, significant losses occur at each stage of the continuum and little is known about contextual factors contributing to disengagement at these stages. This study sought to explore multi-level barriers and facilitators influencing entry into and engagement in the continuum of care in Iringa, Tanzania. We used a mixed-methods study design including facility-based assessments and interviews with providers and clients of HIV testing and treatment services; interviews, focus group discussions and observations with community-based providers and clients of HIV care and support services; and longitudinal interviews with men and women living with HIV to understand their trajectories in care. Data were analyzed using narrative analysis to identify key themes across levels and stages in the continuum of care. Participants identified multiple compounding barriers to progression through the continuum of care at the individual, facility, community and structural levels. Key barriers included the reluctance to engage in HIV services while healthy, rigid clinic policies, disrespectful treatment from service providers, stock-outs of supplies, stigma and discrimination, alternate healing systems, distance to health facilities and poverty. Social support from family, friends or support groups, home-based care providers, income generating opportunities and community mobilization activities facilitated engagement throughout the HIV continuum. Findings highlight the complex, multi-dimensional dynamics that individuals experience throughout the continuum of care and underscore the importance of a holistic and multi-level perspective to understand this process. Addressing barriers at each level is important to promoting increased engagement throughout the continuum.

Factor Influencing HIV Care Continuum among People Living with HIV in Western Kenya

“…More importantly, this study also reveals that those who were on food by prescription were more likely to uptake of ART relative to those who were not. This is consistent with previous studies that have shown that nutritional interventions are not only important in management of HIV and AIDS but also improves patient's general health together these data indicate that nutrition should be integrated with other HIV/AIDS programs with other livelihood programs especially in poor rural settings where food insecurity is common Several studies have revealed that lower education level is an important barrier to early initiation and retention in ART uptake among PLWHIV [20,24].…”

“…In this study a majority of the patients were linked to HIV care verbally or were given referral form to the next step of care with a few being escorted to the HIV care and treatment clinics. Consistent with previous studies, this study found that a majority of HIV patients on care were females [23,24]. Other studies in western Kenya have revealed that men are less likely to report for HIV testing, but even when they report and test positive they are less likely to enroll in HIV care [23].…”

“…Other studies in western Kenya have revealed that men are less likely to report for HIV testing, but even when they report and test positive they are less likely to enroll in HIV care [23]. Similarly a study in Uganda found that that male HIV testing rates and enrolment into care is comparatively lower relative females [24].…”

An Assessment of Quality Assurance in HIV and AIDS-Related Services in Chivuna Rural Health Facility of Southern Zambia

“…Study findings also reveal, a finding not unique to this study but common in many earlier studies also [10] In Chivuna, shortage of staff was also the reason given for providing ART only three times in a week.…”

Frequent HIV Testing: Impact on HIV Risk Among Chinese Men Who Have Sex with Men

“…4–14 HIV testing is the entry point for health services, risk reduction counseling, and the benefits of early ART. 2,15–17 Moreover, seropositive individuals who are aware of their HIV status are often less likely to engage in high-risk behaviors. 18 Reduced risky behaviors, in combination with early and sustained ART adherence, can reduce the likelihood of HIV transmission.…”