Provider and Patient Perspectives of Rapid ART Initiation and Streamlined HIV Care: Qualitative Insights From Eastern African Communities

• Published in: Journal of the International Association of Providers of AIDS Care Vol. 20; p. 23259582211053518
• Main 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., Havlir, Diane V., Camlin, Carol S.
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01.01.2021; SAGE PUBLICATIONS, INC; SAGE Publishing
• Subjects: Anti-HIV Agents - therapeutic use; Antiretroviral drugs; Antiretroviral therapy; Community research; Counseling; Disclosure; Health research; Health services; HIV; HIV Infections - drug therapy; Human immunodeficiency virus; Humans; Original; Patients; Viral Load; HIV care; viral load counseling; care linkage; patient-centered care; viral suppression; rapid ART; differentiated service delivery
• ISSN: 2325-9582; 2325-9574; 2325-9582
• DOI: 10.1177/23259582211053518

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