Marseille 2007
| Abstract #394 - Understanding delays in accessing HIV care and treatment among HIV-positive adults in rural Tanzania | ||||
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Session: 26.88: Posters B (Poster) on Tuesday in Chaired by Authors: Presenting Author: Miss alison wringe - london school of hygiene and tropical medicine, United Kingdom |
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| Additional Authors: Dr Maria Roura, Ms Doris Mbata, Mr Benjamin Nhandi, Mr Ray Nsigaye, Ms Joanna Busza, Ms Basia Zaba, Mr Mark Urassa, | ||||
| Aim: In the context of the Kisesa HIV cohort study in north-west Tanzania, 180 referrals were made to an ART clinic for HIV-positive individuals following voluntary counselling and testing (VCT) between March 2005 and September 2006. ART clinic data suggested that delays in attending appointments were common, with negative implications for treatment outcomes. This qualitative study investigated factors influencing patients attendance at scheduled appointments. | ||||
| Method / Issue: Four sex-specific focus group discussions (FGDs) and 40 in-depth interviews (IDIs) were conducted with HIV-positive adults living in either remote or roadside areas to identify factors influencing their treatment-seeking behaviour. An additional 7 IDIs were carried out with healthcare workers involved in patient referrals to gain their perspective on barriers to patient attendance at clinic appointments. | ||||
| Results / Comments: Factors affecting attendance at ART clinic appointments can be broadly categorised as follows: Health systems barriers: Despite the provision of a transport allowance, the long journey to the clinic presented problems, as did a lack of food during lengthy waiting times, particularly for patients in poor health. The number of appointments, particularly in the pre-ART initiation phase, also affected attendance rates. Psycho-social issues: Stigmatising attitudes from family members and the community were common, and could result in a lack of care at home, or an inability to identify a treatment buddy necessary for starting ART. Feelings of hopelessness, denial of disease progression, and alcohol dependency also emerged as common barriers to regular clinic attendance. Beliefs about ART: Despite generally high levels of knowledge about initiating ART, misconceptions regarding efficacy and duration of HIV treatment existed. Rumours that ART accelerated death were common, and some participants reported that they expected to be cured from HIV, or could stop attending the clinic when feeling well. Alternative services: FGDs indicated that beliefs that HIV was attributable to witchcraft were prevalent, particularly in remote areas, and could lead to patients seeking alternative services. Some patients who concurrently sought treatment from traditional healers were less motivated to maintain clinic attendance and adhere to treatment. There were also some reports of churches promoting miracle cures for HIV as an alternative to biomedical treatment. | ||||
| Discussion: In the short-term, reducing the number of clinic visits prior to ART initiation, through the referral of blood samples for CD4 testing and locally-conducted adherence training could improve attendance at scheduled appointments. In the longer term, scaling up treatment to local health centres is likely to reduce many of the barriers to accessing ART, although perceptions of service quality are likely to remain an important determinant of use. Further research is required to understand the influence of community leaders and traditional healers on treatment-seeking behaviour among HIV-infected patients. This may help to focus interventions to strengthen the links between healthcare providers and traditional healers and religious leaders, so that appropriate support can be provided to help patients sustain appointments at ART clinics. Community mobilisation and additional home-based support are needed to reduce misconceptions and rumours about HIV and ART, and to build a supportive environment for patients seeking treatment and care. | ||||
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