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Barriers and facilitators to linkage to ART in primary care: a qualitative study of patients and providers in Blantyre, Malawi

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MacPherson, Peter ORCID: https://orcid.org/0000-0002-0329-9613, MacPherson, Eleanor, Mwale, Daniel, Squire, Bertie ORCID: https://orcid.org/0000-0001-7173-9038, Makombe, Simon, Corbett, Elizabeth, Lalloo, David ORCID: https://orcid.org/0000-0001-7680-2200 and Desmond, Nicola ORCID: https://orcid.org/0000-0002-2874-8569 (2012) 'Barriers and facilitators to linkage to ART in primary care: a qualitative study of patients and providers in Blantyre, Malawi'. Journal of the International AIDS Society, Vol 15, p. 18020.

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Abstract

Introduction: Linkage from HIV testing and counselling (HTC) to initiation of antiretroviral therapy (ART) is suboptimal in many national programmes in sub-Saharan Africa, leading to delayed initiation of ART and increased risk of death. Reasons for failure of linkage are poorly understood.

Methods: Semi-structured qualitative interviews were undertaken with health providers and HIV-positive primary care patients as part of a prospective cohort study at primary health centres in Blantyre, Malawi. Patients successful and unsuccessful in linking to ART were included.

Results: Progression through the HIV care pathway was strongly influenced by socio-cultural norms, particularly around the perceived need to regain respect lost during a period of visibly declining health. Capacity to call upon the support of networks of families, friends and employers was a key determinant of successful progression. Over-busy clinics, non-functioning laboratories and unsuitable tools used for ART eligibility assessment (WHO clinical staging system and centralized CD4 count measurement) were important health systems determinants of drop-out.

Conclusions: Key interventions that could rapidly improve linkage include guarantee of same-day, same-clinic ART eligibility assessments; utilization of the support offered by peer-groups and community health workers; and integration of HTC and ART programmes.

Item Type: Article
Subjects: WB Practice of Medicine > Therapeutics > WB 330 Drug therapy
WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503 Acquired immunodeficiency syndrome. HIV infections
WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503.2 Therapy
WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503.7 Psychosocial aspects
Faculty: Department: Groups (2002 - 2012) > Clinical Group
Digital Object Identifer (DOI): https://doi.org/10.7448/IAS.15.2.18020
Depositing User: Users 379 not found.
Date Deposited: 03 Jan 2013 17:02
Last Modified: 06 Feb 2018 13:05
URI: http://archive.lstmed.ac.uk/id/eprint/3086

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