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- Title
Provider and Patient Perspectives of Rapid ART Initiation and Streamlined HIV Care: Qualitative Insights From Eastern African Communities.
- Authors
Mwangwa, Florence; Getahun, Monica; Itiakorit, Harriet; Jain, Vivek; Ayieko, James; Owino, Lawrence; Akatukwasa, Cecilia; Maeri, Irene; Koss, Catherine A.; Chamie, Gabriel; Clark, Tamara D.; Kabami, Jane; Atukunda, Mucunguzi; Kwarisiima, Dalsone; Sang, Norton; Bukusi, Elizabeth A.; Kamya, Moses R.; Petersen, Maya L.; Cohen, Craig R.; Charlebois, Edwin D.
- Abstract
The Sustainable East Africa Research in Community Health (SEARCH), a universal test and treat (UTT) trial, implemented 'Streamlined Care'-a multicomponent strategy including rapid linkage to care and antiretroviral therapy (ART) start, 3-monthly refills, viral load counseling, and accessible, patient-centered care provision. To understand patient and provider experiences of Streamlined Care to inform future care innovations, we conducted in-depth interviews with patients (n = 18) and providers (n = 28) at baseline (2014) and follow-up (2015) (n = 17 patients; n = 21 providers). Audio recordings were transcribed, translated, and deductively and inductively coded. Streamlined Care helped to decongest clinic spaces and de-stigmatize human immunodeficiency virus (HIV) care. Patients credited the individualized counselling, provider-assisted HIV status disclosure, and providers' knowledge of patient's drug schedules, availability, and phone call reminders for their care engagement. However, for some, denial (repeated testing to disprove HIV+ results), feeling healthy, limited understanding of the benefits of early ART, and anticipated side-effects, and mistrust of researchers hindered rapid ART initiation. Patients' short and long-term mobility proved challenging for both patients and providers. Providers viewed viral load counselling as a powerful tool to convince otherwise healthy and high-CD4 patients to initiate ART. Patient-centered HIV care models should build on the successes of Streamlined Care, while addressing persistent barriers.#NCT01864683-https://clinicaltrials.gov/ct2/show/NCT01864603.
- Subjects
PATIENTS' attitudes; PERSPECTIVE (Art); HIV; AFRICANS; MEDICAL disclosure
- Publication
Journal of the International Association of Providers of AIDS Care, 2021, p1
- ISSN
2325-9582
- Publication type
journal article
- DOI
10.1177/23259582211053518