Barriers and facilitators to linkage to ART in primary care: a qualitative study of patients and providers in Blantyre,Malawi |
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Authors: | Peter MacPherson Eleanor E MacPherson Daniel Mwale Stephen Bertel Squire Simon D Makombe Elizabeth L Corbett David G Lalloo Nicola Desmond |
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Affiliation: | 1.Clinical Group, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK;2.TB and HIV Group, Malawi–Liverpool–Wellcome Trust Clinical Research Programme, Blantyre, Malawi;3.International Health Group, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK;4.HIV & AIDS Unit, Ministry of Health, Lilongwe, Malawi;5.Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK |
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Abstract: | IntroductionLinkage 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.MethodsSemi-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.ResultsProgression 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.ConclusionsKey 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. |
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Keywords: | HIV testing and counselling antiretroviral therapy linkage to care qualitative studies sub-Saharan Africa |
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