1. Test but not treat: Community members' experiences with barriers and facilitators to universal antiretroviral therapy uptake in rural KwaZulu-Natal, South Africa
- Author
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Maryam Shahmanesh, Melanie Plazy, Rujeko Samanthia Chimukuche, Thembelihle Zuma, Joanna Orne-Gliemann, Collins Iwuji, Janet Seeley, Joseph Larmarange, Mark J. Siedner, Bordeaux population health (BPH), Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre population et développement (CEPED - UMR_D 196), Institut de Recherche pour le Développement (IRD)-Université Paris Cité (UPCité), Santé, vulnérabilités et relations de genre au sud (SAGESUD - ERL Inserm U1244), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre population et développement (CEPED - UMR_D 196), Institut de Recherche pour le Développement (IRD)-Université Paris Cité (UPCité)-Institut de Recherche pour le Développement (IRD)-Université Paris Cité (UPCité), ANRS 2011-375, Agence Nationale de Recherches sur le Sida et les Hépatites Virales, GIZ 81151938, Deutsche Gesellschaft für Internationale Zusammenarbeit, GIZ 81151938, Deutsche Gesellschaft für Muskelkranke, International Initiative for Impact Evaluation Inc, Academy of Medical Sciences, and 201433/Z/16/Z, Wellcome Trust
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RNA viruses ,Male ,Rural Population ,Social Stigma ,Psychological intervention ,Human immunodeficiency virus (HIV) ,Social Sciences ,HIV Infections ,Pathology and Laboratory Medicine ,medicine.disease_cause ,Geographical locations ,Health Services Accessibility ,Cultural Anthropology ,South Africa ,0302 clinical medicine ,Immunodeficiency Viruses ,Sociology ,Antiretroviral Therapy, Highly Active ,Medicine and Health Sciences ,Mass Screening ,Public and Occupational Health ,030212 general & internal medicine ,10. No inequality ,Qualitative Research ,Virus Testing ,Multidisciplinary ,HIV diagnosis and management ,Focus Groups ,Vaccination and Immunization ,3. Good health ,Religion ,Sexual Partners ,Medical Microbiology ,Viral Pathogens ,Viruses ,Medicine ,Female ,Pathogens ,Thematic analysis ,0305 other medical science ,Psychology ,Research Article ,Adult ,Anti-HIV Agents ,Science ,Immunology ,HIV prevention ,MEDLINE ,Antiretroviral Therapy ,Microbiology ,IDLIC ,03 medical and health sciences ,Antiviral Therapy ,Nursing ,Diagnostic Medicine ,Retroviruses ,medicine ,Humans ,Microbial Pathogens ,030505 public health ,Lentivirus ,Organisms ,Biology and Life Sciences ,HIV ,Treatment as prevention ,Focus group ,Antiretroviral therapy ,Health Care ,Health Care Facilities ,Anthropology ,Africa ,Life expectancy ,[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie ,Preventive Medicine ,People and places - Abstract
Introduction\ud Antiretroviral therapy (ART) has revolutionised the care of HIV-positive individuals resulting in marked decreases in morbidity and mortality, and markedly reduced transmission to sexual partners. However, these benefits can only be realised if individuals are aware of their HIV-positive status, initiated and retained on suppressive lifelong ART. Framed using the socio-ecological model, the present study explores factors contributing to poor ART uptake among community members despite high acceptance of HIV-testing within a Treatment as Prevention (TasP) trial. In this paper we identify barriers and facilitators to treatment across different levels of the socio-ecological framework covering individual, community and health system components.\ud \ud Methods\ud This research was embedded within a cluster-randomised trial (ClinicalTrials.gov, number NCT01509508) of HIV treatment as Prevention in rural KwaZulu-Natal, South Africa. Data were collected between January 2013 and July 2014 from resident community members. Ten participants contributed to repeat in-depth interviews whilst 42 participants took part in repeat focus group discussions. Data from individual interviews and focus group discussions were triangulated using community walks to give insights into community members’ perception of the barriers and facilitators of ART uptake. We used thematic analysis guided by a socio-ecological framework to analyse participants’ narratives from both individual interviews and focus group discussions.\ud \ud Results\ud Barriers and facilitators operating at the individual, community and health system levels influence ART uptake. Stigma was an over-arching barrier, across all three levels and expressed variably as fear of HIV disclosure, concerns about segregated HIV clinical services and negative community religious perceptions. Other barriers were individual (substance misuse, fear of ART side effects), community (alternative health beliefs). Facilitators cited by participants included individual (expectations of improved health and longer life expectancy following ART, single tablet regimens), community (availability of ART in the community through mobile trial facilities) and health system factors (fast and efficient service provided by friendly staff).\ud \ud Discussion\ud We identified multiple barriers to achieving universal ART uptake. To enhance uptake in HIV care services, and achieve the full benefits of ART requires interventions that tackle persistent HIV stigma, and offer people with HIV respectful, convenient and efficient services. These interventions require evaluation in appropriately designed studies.
- Published
- 2020
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