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

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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. © 2012 McDougal L et al; licensee International AIDS Society.

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MacPherson, P., MacPherson, E. E., Mwale, D., Squire, S. B., Makombe, S. D., Corbett, E. L., … Desmond, N. (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, 15(2). https://doi.org/10.7448/IAS.15.2.18020

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