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MacPherson, Peter; MacPherson, Eleanor E; Mwale, Daniel; Squire, Stephen Bertel; Makombe, Simon D; Corbett, Elizabeth L; Lalloo, David G; Desmond, Nicola (2012)
Publisher: International AIDS Society
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, Medicine, J, wc_503, wc_503_2, Immunologic diseases. Allergy, DOAJ:Multidisciplinary, wc_503_7, Political science, R, DOAJ:General Works, Social Sciences, wb_330, Research Paper, 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!

    • 1. National Statistics Office. Malawi Demographic and Health Survey. National Statistics Office: Zomba, Malawi; 2010: 193 200.
    • 2. Ministry of Health. Quarterly HIV Programme Report 2011, Q2. Ministry of Health of Malawi: Lilongwe, Malawi; 2011: 1 2.
    • 3. Harries AD, Makombe SD, Libamba E, Schouten EJ. Why did the scale-up of HIV treatment work?: a case example from Malawi. J Acquir Immune Defic Syndr. 2011;57(Suppl 2):S64 7.
    • 4. Lowrance DW, Makombe S, Harries AD, Shiraishi RW, Hochgesang M, Aberle-Grasse J, et al. A public health approach to rapid scale-up of antiretroviral treatment in Malawi during 2004 2006. J Acquir Immune Defic Syndr. 2008;49(3):287 93.
    • 5. De Cock KM, El-Sadr WM, Ghebreyesus TA. Game changers: why did the scale-up of HIV treatment work despite weak health systems? J Acquir Immune Defic Syndr. 2011;57(Suppl 2):S61 3.
    • 6. May M, Boulle A, Phiri S, Messou E, Myer L, Wood R, et al. Prognosis of patients with HIV-1 infection starting antiretroviral therapy in sub-Saharan Africa: a collaborative analysis of scale-up programmes. Lancet. 2010; 376(9739):449 57.
    • 7. UNAIDS. Global report: UNAIDS report on the global AIDS epidemic. UNAIDS: Geneva; 2010.
    • 8. McNairy ML, El-Sadr WM. The HIV care continuum. AIDS 2012;26(14): 1735 8.
    • 9. Johnson LF, Boulle A. How should access to antiretroviral treatment be measured? Bull World Health Organ. 2011;89(2):157 60.
    • 10. Rosen S, Fox MP. Retention in HIV care between testing and treatment in sub-Saharan Africa: a systematic review. PLoS Med. 2011;8(7):e1001056.
    • 11. Bendavid E, Brandeau ML, Wood R, Owens DK. Comparative effectiveness of HIV testing and treatment in highly endemic regions. Arch Intern Med. 2010;170(15):1347 54.
    • 12. Bassett IV, Regan S, Chetty S, Giddy J, Uhler LM, Holst H, et al. Who starts antiretroviral therapy in Durban, South Africa? . . . not everyone who should. AIDS. 2010;24(Suppl 1):S37 44.
    • 13. Losina E, Bassett IV, Giddy J, Chetty S, Regan S, Walensky RP, et al. The ''ART'' of linkage: pre-treatment loss to care after HIV diagnosis at two PEPFAR sites in Durban, South Africa. PLoS One. 2010;5(3):e9538.
    • 14. Macpherson P, Lalloo DG, Choko AT, Mann GH, Squire SB, Mwale D, et al. Suboptimal patterns of provider initiated HIV testing and counselling, antiretroviral therapy eligibility assessment and referral in primary health clinic attendees in Blantyre, Malawi. Trop Med Int Health. 2012;17(4): 507 17.
    • 15. Macpherson P, Corbett EL, Makombe SD, van Oosterhout JJ, Manda E, Choko AT, et al. Determinants and consequences of failure of linkage to antiretroviral therapy at primary care level in Blantyre, Malawi: a prospective cohort study. PLoS One. 2012;7(9):e44794.
    • 16. Ministry of Health of Malawi. Guidelines for the use of antiretroviral therapy in Malawi. Ministry of Health of Malawi: Lilongwe, Malawi; 2008.
    • 17. Zachariah R, Van Engelgem I, Massaquoi M, Kocholla L, Manzi M, Suleh A, et al. Payment for antiretroviral drugs is associated with a higher rate of patients lost to follow-up than those offered free-of-charge therapy in Nairobi, Kenya. Trans R Soc Trop Med Hyg. 2008;102(3):288 93.
    • 18. Benson T, Payongayong E, Ahmed A, Sharma M. Simple household poverty assessment models for Malawi. In: Conference of the International Association of Agricultural Economists (IAAE). Gold Coast, Australia; 2006.
    • 19. Ritchie J, Lewis J. Qualitative research practice: a guide for social science students and researchers. Thousand Oaks, CA: Sage; 2003.
    • 20. Hayden J. Introduction to health behavior theory. Sudbury, MA: Jones and Bartlett; 2009.
    • 21. Roura M, Busza J, Wringe A, Mbata D, Urassa M, Zaba B. Barriers to sustaining antiretroviral treatment in Kisesa, Tanzania: a follow-up study to understand attrition from the antiretroviral program. AIDS Patient Care STDS. 2009;23(3):203 10.
    • 22. Bassett IV, Wang B, Chetty S, Mazibuko M, Bearnot B, Giddy J, et al. Loss to care and death before antiretroviral therapy in Durban, South Africa. J Acquir Immune Defic Syndr. 2009;51(2):135 9.
    • 23. Govindasamy D, van Schaik N, Kranzer K, Wood R, Mathews C, Bekker L-G. Linkage to HIV care from a mobile testing unit in South Africa by different CD4 count strata. J Acquir Immune Defic Syndr. 2011;58(3):344 52.
    • 24. Zachariah R, Harries AD, Manzi M, Gomani P, Teck R, Phillips M, et al. Acceptance of anti-retroviral therapy among patients infected with HIV and tuberculosis in rural Malawi is low and associated with cost of transport. PLoS One. 2006;1:e121.
    • 25. Kemp J, Mann GH, Nhlema Simwaka B, Salaniponi FL, Squire SB. Can Malawi's poor afford free tuberculosis sevices? Patient and household costs associated with a tuberculosis diagnosis in Lilongwe. Bull World Health Organ. 2007;85(8):580 5.
    • 26. Jani IV, Sitoe NE, Alfai ER, Chongo PL, Quevedo JI, Rocha BM, et al. Effect of point-of-care CD4 cell count tests on retention of patients and rates of antiretroviral therapy initiation in primary health clinics: an observational cohort study. Lancet. 2011;378(9802):1572 9.
    • 27. Zachariah R, Ford N, Maher D, Bissell K, Van den Bergh R, van den Boogaard W, et al. Is operational research delivering the goods? The journey to success in low-income countries. Lancet Infect Dis. 2012;12(5):415 21.
    • 28. Foster SD, Nakamanya S, Kyomuhangi R, Amurwon J, Namara G, Amuron B, et al. The experience of ''medicine companions'' to support adherence to antiretroviral therapy: quantitative and qualitative data from a trial population in Uganda. AIDS care. 2010;22(Suppl 1):35 43.
    • 29. Nachega JB, Chaisson RE, Goliath R, Efron A, Chaudhary MA, Ram M, et al. Randomized controlled trial of trained patient-nominated treatment supporters providing partial directly observed antiretroviral therapy. AIDS. 2010;24(9):1273 80.
    • 30. Thomas F. Stigma, fatigue and social breakdown: exploring the impacts of HIV/AIDS on patient and carer well-being in the Caprivi Region, Namibia. Soc Sci Med. 2006;63(12):3174 87.
    • 31. Chimwaza AF, Watkins SC. Giving care to people with symptoms of AIDS in rural sub-Saharan Africa. AIDS care. 2004;16(7):795 807.
    • 32. Uebel KE, Nash J, Avalos A. Caring for the caregivers: models of HIV/AIDS care and treatment provision for health care workers in Southern Africa. J Infect Dis. 2007;196(Supp 3):S500 4.
    • 33. United Nations Human Rights, World Health Organization, UNAIDS. Disability and HIV. Policy brief. United Nations: New York; 2009.
    • 34. MacPherson P, Webb EL, Choko AT, Desmond N, Chavula K, Napierala Mavedzenge S, et al. Stigmatising attitudes among people offered home-based HIV testing and counselling in Blantyre, Malawi: construction and analysis of a stigma scale. PLoS One. 2011;6(10):e26814.
    • 35. Brown L, Macintyre K, Trujillo L. Interventions to reduce HIV/AIDS stigma: what have we learned? AIDS Educ Prev. 2003;15(1):49 69.
    • 36. Corbett EL, Dauya E, Matambo R, Cheung YB, Makamure B, Bassett MT, et al. Uptake of workplace HIV counselling and testing: a cluster-randomised trial in Zimbabwe. PLoS Med. 2006;3(7):e238.
    • 37. Mavhu W, Dauya E, Bandason T, Munyati S, Cowan FM, Hart G, et al. Chronic cough and its association with TB HIV co-infection: factors affecting help-seeking behaviour in Harare, Zimbabwe. Trop Med Int Health. 2010; 15(5):574 9.
    • 38. Daftary A, Padayatchi N. Social constraints to TB/HIV healthcare: accounts from coinfected patients in South Africa. AIDS Care 2012;24(12):1480 6.
    • 39. Chang LW, Kagaayi J, Arem H, Nakigozi G, Ssempijja V, Serwadda D, et al. Impact of a mHealth intervention for peer health workers on AIDS care in rural Uganda: a mixed methods evaluation of a cluster-randomized trial. AIDS Behav. 2011;15(8):1776 84.
    • 40. Raviglione MC, Dye C, Schmidt S, Kochi A. Assessment of worldwide tuberculosis control. The Lancet. 1997;350(9078):624 9.
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