NIMR-Mwanza Medical Research Centre, P.O Box 1462, Mwanza, Tanzania.
School of Public Health- University of Western Cape, Cape Town, South Africa.
BMC Public Health. 2019 Apr 5;19(1):383. doi: 10.1186/s12889-019-6691-7.
In remote rural Tanzania, the rate of linkage into HIV care was estimated at 28% in 2014. This study explored facilitators and barriers to linkage to HIV care at individual/patient, health care provider, health system, and contextual levels to inform eventual design of interventions to improve linkage to HIV care.
We conducted a descriptive qualitative study nested in a cohort study of 1012 newly diagnosed HIV-positive individuals in Mbeya region between August 2014 and July 2015. We conducted 8 focus group discussions and 10 in-depth interviews with recently diagnosed HIV-positive individuals and 20 individual interviews with healthcare providers. Transcripts were analyzed inductively using thematic content analysis. The emergent themes were then deductively fitted into the four level ecological model.
We identified multiple factors influencing linkage to care. HIV status disclosure, support from family/relatives and having symptoms of disease were reported to facilitate linkage at the individual level. Fear of stigma, lack of disclosure, denial and being asymptomatic, belief in witchcraft and spiritual beliefs were barriers identified at individual's level. At providers' level; support and good patient-staff relationship facilitated linkage, while negative attitudes and abusive language were reported barriers to successful linkage. Clear referral procedures and well-organized clinic procedures were system-level facilitators, whereas poorly organized clinic procedures and visit schedules, overcrowding, long waiting times and lack of resources were reported barriers. Distance and transport costs to HIV care centers were important contextual factors influencing linkage to care.
Linkage to HIV care is an important step towards proper management of HIV. We found that access and linkage to care are influenced positively and negatively at all levels, however, the individual-level and health system-level factors were most prominent in this setting. Interventions must address issues around stigma, denial and inadequate awareness of the value of early linkage to care, and improve the capacity of HIV treatment/care clinics to implement quality care, particularly in light of adopting the 'Test and Treat' model of HIV treatment and care recommended by the World Health Organization.
2014 年，坦桑尼亚偏远农村地区的艾滋病毒感染者开始接受治疗的比例估计为 28%。本研究旨在探讨个人/患者、医疗服务提供者、卫生系统和背景等各个层面影响艾滋病毒感染者开始接受治疗的因素，以便为改善艾滋病毒感染者开始接受治疗的干预措施提供信息。
我们在坦桑尼亚姆贝亚地区开展了一项队列研究，该研究于 2014 年 8 月至 2015 年 7 月期间纳入了 1012 名新诊断的艾滋病毒阳性患者。我们对新诊断的艾滋病毒阳性患者进行了 8 次焦点小组讨论和 10 次深入访谈，对医护人员进行了 20 次个人访谈。使用主题内容分析法对转录本进行了归纳分析。然后，将出现的主题演绎地纳入四级生态模式。
我们发现了多种影响开始接受治疗的因素。艾滋病毒感染者的身份披露、家人/亲戚的支持和出现疾病症状，这些因素在个人层面上有助于开始接受治疗。而在个人层面上，发现的障碍因素包括恐惧污名化、缺乏披露、否认和无症状、相信巫术和精神信仰。在提供者层面，支持和良好的医患关系促进了开始接受治疗，而消极的态度和辱骂性语言则被报道为成功开始接受治疗的障碍。明确的转诊程序和组织良好的诊所程序是系统层面的促进因素，而组织不善的诊所程序和就诊时间表、过度拥挤、长时间等待和资源缺乏则是报告的障碍。艾滋病毒护理中心的距离和交通费用是影响开始接受治疗的重要背景因素。
开始接受艾滋病毒治疗是适当管理艾滋病毒的重要步骤。我们发现，在所有层面上，开始接受艾滋病毒治疗都受到积极和消极的影响，然而，在这种情况下，个人层面和卫生系统层面的因素最为突出。干预措施必须解决污名化、否认和对早期开始接受治疗的重要性认识不足等问题，并提高艾滋病毒治疗/护理诊所提供优质护理的能力，特别是考虑到世界卫生组织推荐的采用“检测和治疗”艾滋病毒治疗和护理模式。
