Barriers and facilitators to linkage to ART in primary care: a qualitative study of patients and providers in Blantyre, Malawi

MacPherson, Peter, MacPherson, Eleanor E, Mwale, Daniel, Squire, Stephen Bertel, Makombe, Simon D, Corbett, Elizabeth L, Lalloo, David G and Desmond, Nicola (2012) Barriers and facilitators to linkage to ART in primary care: a qualitative study of patients and providers in Blantyre, Malawi JOURNAL OF THE INTERNATIONAL AIDS SOCIETY, 15 (2). 18020-. ISSN 1758-2652, 1758-2652

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Abstract

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. 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. 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. 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. © 2012 McDougal L et al; licensee International AIDS Society.

Item Type:	Article
Additional Information:	MacPherson, Peter MacPherson, Eleanor E Mwale, Daniel Bertel Squire, Stephen Makombe, Simon D Corbett, Elizabeth L Lalloo, David G Desmond, Nicola WT089673/Wellcome Trust/United Kingdom Research Support, Non-U.S. Gov't Switzerland J Int AIDS Soc. 2012 Dec 31;15(2):18020. doi: 10.7448/IAS.15.2.18020.## TULIP Type: Articles/Papers (Journal) ##
Uncontrolled Keywords:	HIV testing and counselling, antiretroviral therapy, linkage to care, qualitative studies, sub-Saharan Africa
Depositing User:	Symplectic Admin
Date Deposited:	08 Jun 2016 14:44
Last Modified:	16 Jun 2026 04:09
DOI:	10.7448/IAS.15.2.18020
Related Websites:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3001614
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