%0 Journal Article
%T Barriers and facilitators to linkage to ART in primary care: a qualitative study of patients and providers in Blantyre, Malawi
%A Peter MacPherson
%A Eleanor E MacPherson
%A Daniel Mwale
%A Stephen Bertel Squire
%J Journal of the International AIDS Society
%D 2012
%I 
%R 10.7448/ias.15.2.18020
%X 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.
%K HIV testing and counselling
%K antiretroviral therapy
%K linkage to care
%K qualitative studies
%K sub-Saharan Africa
%U http://www.jiasociety.org/index.php/jias/article/view/18020/2778