Understanding factors influencing linkage to HIV care in a rural setting, Mbeya, Tanzania: qualitative findings of a mixed methods study

Abstract

Background In remote rural Tanzania, the rate of linkage into HIV care was estimated at 28% in 2014. This study explored facilitators and barriers to linkage to HIV care at individual/patient, health care provider, health system, and contextual levels to inform eventual design of interventions to improve linkage to HIV care. Methods We conducted a descriptive qualitative study nested in a cohort study of 1012 newly diagnosed HIV-positive individuals in Mbeya region between August 2014 and July 2015. We conducted 8 focus group discussions and 10 in-depth interviews with recently diagnosed HIV-positive individuals and 20 individual interviews with healthcare providers. Transcripts were analyzed inductively using thematic content analysis. The emergent themes were then deductively fitted into the four level ecological model. Results We identified multiple factors influencing linkage to care. HIV status disclosure, support from family/relatives and having symptoms of disease were reported to facilitate linkage at the individual level. Fear of stigma, lack of disclosure, denial and being asymptomatic, belief in witchcraft and spiritual beliefs were barriers identified at individual’s level. At providers’ level; support and good patient-staff relationship facilitated linkage, while negative attitudes and abusive language were reported barriers to successful linkage. Clear referral procedures and well-organized clinic procedures were system-level facilitators, whereas poorly organized clinic procedures and visit schedules, overcrowding, long waiting times and lack of resources were reported barriers. Distance and transport costs to HIV care centers were important contextual factors influencing linkage to care. Conclusion Linkage to HIV care is an important step towards proper management of HIV. We found that access and linkage to care are influenced positively and negatively at all levels, however, the individual-level and health system-level factors were most prominent in this setting. Interventions must address issues around stigma, denial and inadequate awareness of the value of early linkage to care, and improve the capacity of HIV treatment/care clinics to implement quality care, particularly in light of adopting the ‘Test and Treat’ model of HIV treatment and care recommended by the World Health Organization.

Does distance from a clinic and poverty impact visit adherence for noncommunicable diseases? A retrospective cohort study using electronic medical records in rural Haiti

“…Many factors have been associated with retention in care, including individual level factors (feeling sick and having symptoms, moral support from relatives, fear of stigma, misunderstanding about importance of care, financial constraints), provider level (negative healthcare provider attitudes, abusive language), health system level (overcrowding, inadequate resources), and contextual factors (proximity to clinic) [ 15 – 17 ]. Prior non-retention and tracing studies for HIV care to find patients who have been lost to follow-up have shown an inverse association between poverty and attendance at clinic [ 17 , 29 , 30 ].…”

“…3 months) with at least one visit, and gaps between visits [ 12 ]. Various patient and healthcare system factors have been associated with retention in care, including degree of symptoms, financial constraints, distance from the clinic, decreased wait times, and improved patient satisfaction [ 15 – 17 ]. While routinely measured in the HIV/AIDS care continuum literature and linked to viral loads [ 18 , 19 ], medication adherence, and mortality [ 20 , 21 ], visit adherence and its predictors have not been routinely examined for chronic disease care in LMIC.…”

Level of Quality of Option B+PMTCT Service Provision in Public Health Facilities in Mekelle Zone, Northern Ethiopia: Cross-sectional study

“…Variation of the finding in the later study might be due to their good experience in implementing the service since it was an area in which Option B + PMTCT first piloted internationally [29]. Identified barriers for process related factors during an interview were poor service adherence to service standards, work load, and prolonged waiting time which were similarly reported from [30,34,35]. This process related factors had serious implications in compromising the overall quality of care currently aspired in 2020 [10,19].…”

Health communication in low-income countries: A 60-year bibliometric and thematic analysis

“…[ 19 ] Tanzania's health communication research in the rural areas studied the influence of HIV care and examined the reaction of HIV prevention methods done in those areas. [ 20 21 ] Other studies focused on the risks associated with sexual relationship between homosexual men and its implications for HIV, the importance of parental communication in supporting HIV patients, and the significance of social networks in increasing the willingness for HIV self-testing. [ 22 23 24 25 ]…”