Open AccessBarriers and facilitators to linkage to ART in primary care: a qualitative study of patients and providers in Blantyre, Malawi
Author(s) -
MacPherson Peter,
MacPherson Eleanor E,
Mwale Daniel,
Squire Stephen Bertel,
Makombe Simon D,
Corbett Elizabeth L,
Lalloo David G,
Desmond Nicola
Publication year - 2012
Publication title -
journal of the international aids society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.724
H-Index - 62
ISSN - 1758-2652
DOI - 10.7448/ias.15.2.18020
Subject(s) - medicine , psychological intervention , qualitative research , family medicine , antiretroviral therapy , linkage (software) , cohort , health care , human immunodeficiency virus (hiv) , nursing , viral load , biochemistry , sociology , economics , gene , economic growth , chemistry , social science
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.