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Peter MacPherson; Eleanor E MacPherson; Daniel Mwale; Stephen Bertel Squire; Simon D Makombe; Elizabeth L Corbett; David G Lalloo; Nicola Desmond (2012)
Publisher: Wiley
Journal: Journal of the International AIDS Society
Languages: English
Types: Article
Subjects: A, RC581-607, HIV testing and counselling, antiretroviral therapy, linkage to care, qualitative studies, H, wc_503, wc_503_2, Medicine, J, Immunologic diseases. Allergy, wc_503_7, DOAJ:Multidisciplinary, Political science, R, DOAJ:General Works, Social Sciences, Research Paper, wb_330, sub-Saharan Africa, General Works
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.\ud \ud 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.\ud \ud 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.\ud \ud 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.
  • The results below are discovered through our pilot algorithms. Let us know how we are doing!

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