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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Multi-level factors affecting entry into and engagement in the HIV continuum of care in Iringa, Tanzania
PLoS ONE, Volume 9, No. 8, Article e104961, Year 2014
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Description
Progression through the HIV continuum of care, from HIV testing to lifelong retention in antiretroviral therapy (ART) care and treatment programs, is critical to the success of HIV treatment and prevention efforts. However, significant losses occur at each stage of the continuum and little is known about contextual factors contributing to disengagement at these stages. This study sought to explore multi-level barriers and facilitators influencing entry into and engagement in the continuum of care in Iringa, Tanzania. We used a mixed-methods study design including facility-based assessments and interviews with providers and clients of HIV testing and treatment services; interviews, focus group discussions and observations with community-based providers and clients of HIV care and support services; and longitudinal interviews with men and women living with HIV to understand their trajectories in care. Data were analyzed using narrative analysis to identify key themes across levels and stages in the continuum of care. Participants identified multiple compounding barriers to progression through the continuum of care at the individual, facility, community and structural levels. Key barriers included the reluctance to engage in HIV services while healthy, rigid clinic policies, disrespectful treatment from service providers, stock-outs of supplies, stigma and discrimination, alternate healing systems, distance to health facilities and poverty. Social support from family, friends or support groups, home-based care providers, income generating opportunities and community mobilization activities facilitated engagement throughout the HIV continuum. Findings highlight the complex, multi-dimensional dynamics that individuals experience throughout the continuum of care and underscore the importance of a holistic and multi-level perspective to understand this process. Addressing barriers at each level is important to promoting increased engagement throughout the continuum. © 2014 Layer et al.
Authors & Co-Authors
Layer, Erica H.
United States, Baltimore
Johns Hopkins Bloomberg School of Public Health
Kennedy, Caitlin E.
United States, Baltimore
Johns Hopkins Bloomberg School of Public Health
Beckham, Sarah W.
United States, Baltimore
Johns Hopkins Bloomberg School of Public Health
Mbwambo, Jessie Kazeni Kilonzo
Tanzania, Dar es Salaam
Muhimbili University of Health and Allied Sciences
Likindikoki, Samuel Lazarus
Tanzania, Dar es Salaam
Muhimbili University of Health and Allied Sciences
Davis, Wendy Wakefield
United States, Baltimore
Johns Hopkins Bloomberg School of Public Health
Kerrigan, Deanna L.
United States, Baltimore
Johns Hopkins Bloomberg School of Public Health
Brahmbhatt, Heena
United States, Baltimore
Johns Hopkins Bloomberg School of Public Health
Ntogwisangu, Jacob
Tanzania, Dar es Salaam
Muhimbili University of Health and Allied Sciences
Mwampashi, Ard
Tanzania, Dar es Salaam
Muhimbili University of Health and Allied Sciences
Shembilu, Catherine R.
Tanzania, Dar es Salaam
Muhimbili University of Health and Allied Sciences
Gitagno, David
Tanzania, Dar es Salaam
Muhimbili University of Health and Allied Sciences
Mgeni, Lilian
Tanzania, Dar es Salaam
Muhimbili University of Health and Allied Sciences
Peter, Maureen
Tanzania, Dar es Salaam
Muhimbili University of Health and Allied Sciences
Laizer, Editha
Tanzania, Dar es Salaam
Muhimbili University of Health and Allied Sciences
Massawe, Emmanuel
Tanzania, Dar es Salaam
Muhimbili University of Health and Allied Sciences
Statistics
Citations: 141
Authors: 16
Affiliations: 2
Identifiers
Doi:
10.1371/journal.pone.0104961
e-ISSN:
19326203
Research Areas
Health System And Policy
Infectious Diseases
Study Design
Cohort Study
Narrative Study
Study Approach
Qualitative
Study Locations
Tanzania
Participants Gender
Male
Female