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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
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, Volume 15, No. 2, Article 18020, Year 2012
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Description
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.
Authors & Co-Authors
MacPherson, Peter
Unknown Affiliation
MacPherson, Eleanor Elizabeth
Unknown Affiliation
Mwale, Daniel
Unknown Affiliation
Squire, S. Bertel
Unknown Affiliation
Makombe, Simon D.
Unknown Affiliation
Corbett, Elizabeth L.
Unknown Affiliation
Lalloo, David G.
Unknown Affiliation
Desmond, Nicola Ann
Unknown Affiliation
Statistics
Citations: 71
Authors: 8
Affiliations: 5
Identifiers
Doi:
10.7448/IAS.15.2.18020
e-ISSN:
17582652
Research Areas
Health System And Policy
Infectious Diseases
Study Design
Cohort Study
Study Approach
Qualitative
Quantitative
Study Locations
Malawi