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.
journal_name
J Int AIDS Socjournal_title
Journal of the International AIDS Societyauthors
MacPherson P,MacPherson EE,Mwale D,Bertel Squire S,Makombe SD,Corbett EL,Lalloo DG,Desmond Ndoi
10.7448/IAS.15.2.18020subject
Has Abstractpub_date
2012-12-31 00:00:00pages
18020issue
2issn
1758-2652pii
18020journal_volume
15pub_type
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