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Provider and Patient Perspectives of Rapid ART Initiation and Streamlined HIV Care: Qualitative Insights From Eastern African Communities
- 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;
- Havlir, Diane V;
- Camlin, Carol S
- et al.
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.
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