Burden of Disease Research Unit, South African Medical Research Council, P.O. Box 19070, TygerbergCape Town, 7505, South Africa.
Division of Health Systems and Public Health, Stellenbosch University, Cape Town, South Africa.
BMC Public Health. 2023 Sep 9;23(1):1756. doi: 10.1186/s12889-023-16576-w.
Ending AIDS by 2030 would depend on how successful health systems are in linking people living with HIV (PLHIV) into care. The World Health Organization recommended the 'Universal Test and Treat' (UTT) strategy - initiating all individuals testing positive on antiretroviral therapy (ART) irrespective of their CD4 count and clinical staging. This study aimed to explore the enablers and barriers to linkage to HIV care among adults with a new HIV diagnosis in a high-HIV prevalent rural district in South Africa. A qualitative study was undertaken to explore patients' perceptions of enablers and barriers of linkage-to-care, using a life-story narration and dialogue approach. In-depth interviews were conducted with 38 HIV-positive participants sampled from a cohort of 1194 HIV-positive patients recruited from December 2017 to June 2018. Participants were selected based on whether they had been linked to care or not within 3 months of positive HIV diagnosis. Interviews were thematically analysed using a general inductive approach. Of the 38 participants, 22 (58%) linked to care within three months of HIV-positive diagnosis. Factors that facilitated or inhibited linkage-to-care were found at individual, family, community, as well as health systems levels. Enablers included a positive HIV testing experience, and assistance from the fieldwork team. Support from family, and friends, as well as prior community-based education about HIV and ART were also noted. Individual factors such as acceptance of HIV status, previous exposure to PLHIV, and fear of HIV progressing, were identified. Barriers to linkage included, denial of HIV status, dislike of taking pills, and preference for alternative medicine. Negative experiences with counselling and health systems inefficiency were also noted as barriers. Perceived stigma and socio-economic factors, such as lack of food or money to visit the clinic were other barriers. Community-based and health system-level interventions would need to focus on clinic readiness in providing patients with necessary and effective health services such as proper and adequate counselling. This could increase the number of patients who link to care. Finally, interventions to improve linkage-to-care should consider a holistic approach, including training healthcare providers, community outreach and the provision of psychological, social, and financial support.
到 2030 年终结艾滋病，将取决于卫生系统在将艾滋病毒感染者（PLHIV）纳入治疗方面的成功程度。世界卫生组织建议采用“普遍检测和治疗”（UTT）策略，即对所有接受抗逆转录病毒治疗（ART）检测呈阳性的个体进行治疗，而不论其 CD4 计数和临床分期如何。本研究旨在探索在南非一个艾滋病毒高流行的农村地区，新诊断出艾滋病毒的成年人与艾滋病毒护理建立联系的促进因素和障碍。采用生活故事叙述和对话方法，开展了一项定性研究，以探索患者对建立联系的促进因素和障碍的看法。对 2017 年 12 月至 2018 年 6 月从 1194 名 HIV 阳性患者队列中招募的 38 名 HIV 阳性参与者进行了深入访谈。根据他们在 HIV 阳性诊断后 3 个月内是否已建立联系来选择参与者。使用一般归纳方法对访谈进行主题分析。在 38 名参与者中，有 22 名（58%）在 HIV 阳性诊断后 3 个月内建立了联系。在个人、家庭、社区以及卫生系统层面发现了促进或阻碍建立联系的因素。促进因素包括 HIV 检测体验良好，以及野外工作队的帮助。家庭和朋友的支持，以及以前社区中关于 HIV 和 ART 的教育也受到了关注。还确定了一些个人因素，例如接受 HIV 状况、以前接触过 PLHIV 以及担心 HIV 进展。建立联系的障碍包括否认 HIV 状况、不喜欢服用药物以及偏爱替代药物。还提到了对咨询和卫生系统效率低下的负面体验。感知到的耻辱感和社会经济因素，例如缺乏食物或金钱来就诊，也是其他障碍。以社区为基础和以卫生系统为基础的干预措施需要侧重于为患者提供必要和有效的卫生服务，例如适当和充足的咨询，以确保诊所做好准备。这可以增加与护理建立联系的患者人数。最后，改善建立联系的干预措施应考虑采用整体方法，包括培训医疗保健提供者、社区外展以及提供心理、社会和财政支持。
