Journal Article

Understanding factors influencing linkage to HIV care in a rural setting, Mbeya, Tanzania: qualitative findings of a mixed methods study

Lerebo, Wondwossen, Mushi, Adiel K., Sanga, Erica S., Mukumbang, Ferdinand C., Zarowsky, Christina

2019

Overview

Background In remote rural Tanzania, the rate of linkage into HIV care was estimated at 28% in 2014. This study explored facilitators and barriers to linkage to HIV care at individual/patient, health care provider, health system, and contextual levels to inform eventual design of interventions to improve linkage to HIV care. Methods We conducted a descriptive qualitative study nested in a cohort study of 1012 newly diagnosed HIV-positive individuals in Mbeya region between August 2014 and July 2015. We conducted 8 focus group discussions and 10 in-depth interviews with recently diagnosed HIV-positive individuals and 20 individual interviews with healthcare providers. Transcripts were analyzed inductively using thematic content analysis. The emergent themes were then deductively fitted into the four level ecological model. Results We identified multiple factors influencing linkage to care. HIV status disclosure, support from family/relatives and having symptoms of disease were reported to facilitate linkage at the individual level. Fear of stigma, lack of disclosure, denial and being asymptomatic, belief in witchcraft and spiritual beliefs were barriers identified at individual’s level. At providers’ level; support and good patient-staff relationship facilitated linkage, while negative attitudes and abusive language were reported barriers to successful linkage. Clear referral procedures and well-organized clinic procedures were system-level facilitators, whereas poorly organized clinic procedures and visit schedules, overcrowding, long waiting times and lack of resources were reported barriers. Distance and transport costs to HIV care centers were important contextual factors influencing linkage to care. Conclusion Linkage to HIV care is an important step towards proper management of HIV. We found that access and linkage to care are influenced positively and negatively at all levels, however, the individual-level and health system-level factors were most prominent in this setting. Interventions must address issues around stigma, denial and inadequate awareness of the value of early linkage to care, and improve the capacity of HIV treatment/care clinics to implement quality care, particularly in light of adopting the ‘Test and Treat’ model of HIV treatment and care recommended by the World Health Organization.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Acquired immune deficiency syndrome / Adult / AIDS / AIDS treatment / Ambulatory Care Facilities / Barriers to HIV care linkage / Biostatistics / Care and treatment / Cohort Studies / Content analysis / Continuity of Patient Care / Counseling / Depth perception / Diagnosis / Disclosure / Disclosure of information / Ecological effects / Ecological models / Environmental Health / Epidemiology / Facilitators to HIV care linkage / Female / Focus Groups / Health / Health care / Health care industry / Health care reform / Health facilities / Health Personnel / Health policies / Health Services Accessibility / HIV / HIV infections / HIV Infections - diagnosis / HIV Infections - therapy / HIV patients / Human immunodeficiency virus / Humans / Linkage to care / Male / Medical care quality / Medical tests / Medicine / Medicine & Public Health / Mixed methods research / Model testing / Overcrowding / Patients / Professional-Patient Relations / Public Health / Qualitative Research / Quality management / Quality of care / Referral and Consultation / Research Article / Retention / Risk factors / Rural areas / Rural Population / Schedules / Signs and symptoms / Social Stigma / Studies / Systematic review / systems and management in low and middle-income countries / Tanzania / Vaccine / Witchcraft