About this Journal Submit a Manuscript Table of Contents
BioMed Research International
Volume 2013 (2013), Article ID 470245, 7 pages
http://dx.doi.org/10.1155/2013/470245
Research Article

A Qualitative Study of Barriers to Enrollment into Free HIV Care: Perspectives of Never-in-Care HIV-Positive Patients and Providers in Rakai, Uganda

1Rakai Health Sciences Program, P.O. Box 279, Kalisizo, Rakai, Uganda
2Department of Community Health and Behavioral Sciences, Makerere University School of Public Health, P.O. Box 7072, Kampala, Uganda
3Department of Medicine, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda
4Department of Epidemiology and Biostatistics, Makerere University School of Public Health, P.O. Box 7072, Kampala, Uganda
5Johns Hopkins School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287, USA
6Department of Disease Control and Environmental Health, Makerere University School of Public Health, P.O. Box 7072, Kampala, Uganda
7Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 627 N. Washington Street, Baltimore, MD 21205, USA

Received 30 April 2013; Accepted 23 July 2013

Academic Editor: Holly Seale

Copyright © 2013 Gertrude Nakigozi et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Linked References

  1. J. Mermin, J. P. Ekwaru, C. A. Liechty et al., “Effect of co-trimoxazole prophylaxis, antiretroviral therapy, and insecticide-treated bednets on the frequency of malaria in HIV-1-infected adults in Uganda: a prospective cohort study,” The Lancet, vol. 367, no. 9518, pp. 1256–1261, 2006. View at Publisher · View at Google Scholar · View at Scopus
  2. S. M. Graham, L. Masese, R. Gitau et al., “Antiretroviral adherence and development of drug resistance are the strongest predictors of genital HIV-1 shedding among women initiating treatment,” Journal of Infectious Diseases, vol. 202, no. 10, pp. 1538–1542, 2010. View at Publisher · View at Google Scholar · View at Scopus
  3. R. Granich, S. Crowley, M. Vitoria et al., “Highly active antiretroviral treatment for the prevention of HIV transmission,” Journal of the International AIDS Society, vol. 13, no. 1, p. 1, 2010. View at Publisher · View at Google Scholar · View at Scopus
  4. DHHS, Department of Health and Human Services [DHHS] Panel on Antiretroviral Guidelines For Adults and Adolescents, Department of Health and Human Services, Hobart, Australia, 2011.
  5. B. Amuron, G. Namara, J. Birungi et al., “Mortality and loss-to-follow-up during the pre-treatment period in an antiretroviral therapy programme under normal health service conditions in Uganda,” BMC Public Health, vol. 9, p. 290, 2009. View at Publisher · View at Google Scholar · View at Scopus
  6. E. Losina, I. V. Bassett, J. Giddy et al., “The “ART” of linkage: pre-treatment loss to care after HIV diagnosis at two PEPFAR sites in Durban, South Africa,” PLoS ONE, vol. 5, no. 3, Article ID e9538, 2010. View at Publisher · View at Google Scholar · View at Scopus
  7. I. V. Bassett, B. Wang, S. Chetty et al., “Loss to care and death before antiretroviral therapy in Durban, South Africa,” Journal of Acquired Immune Deficiency Syndromes, vol. 51, no. 2, pp. 135–139, 2009. View at Publisher · View at Google Scholar · View at Scopus
  8. G. Nakigozi, F. Makumbi, S. Reynolds et al., “Non-enrollment for free community HIV care: findings from a population-based study in Rakai, Uganda,” AIDS Care, vol. 23, no. 6, pp. 764–770, 2011. View at Publisher · View at Google Scholar · View at Scopus
  9. J. H. Samet, K. A. Freedberg, M. D. Stein et al., “Trillion virion delay: time from testing positive for HIV to presentation for primary care,” Archives of Internal Medicine, vol. 158, no. 7, pp. 734–740, 1998. View at Publisher · View at Google Scholar · View at Scopus
  10. K. N. Althoff, S. Gange, M. B. Klein, et al., “Late presentation for human immunodeficiency virus care in the United States and Canada,” Clinical Infectious Diseases, vol. 50, no. 11, pp. 1512–1520, 2010. View at Publisher · View at Google Scholar
  11. J. L. Fagan, J. Bertolli, and A. D. McNaghten, “Understanding people who have never received HIV medical care: a population-based approach,” Public Health Reports, vol. 125, no. 4, pp. 520–527, 2010. View at Scopus
  12. G. Marks, L. I. Gardner, J. Craw, and N. Crepaz, “Entry and retention in medical care among HIV-diagnosed persons: a meta-analysis,” AIDS, vol. 24, no. 17, pp. 2665–2678, 2010. View at Publisher · View at Google Scholar · View at Scopus
  13. M. Posse and R. Baltussen, “Barriers to access to antiretroviral treatment in mozambique, as perceived by patients and health workers in urban and rural settings,” AIDS Patient Care and STDs, vol. 23, no. 10, pp. 867–875, 2009. View at Publisher · View at Google Scholar · View at Scopus
  14. G. Wagner, G. Ryan, and S. Taylor, “Formative evaluation of antiretroviral therapy scale-up efficiency in sub-Saharan Africa,” AIDS Patient Care and STDs, vol. 21, no. 11, pp. 871–887, 2007. View at Publisher · View at Google Scholar · View at Scopus
  15. G. H. Mshana, J. Wamoyi, J. Busza et al., “Barriers to accessing antiretroviral therapy in Kisesa, Tanzania: a qualitative study of early rural referrals to the national program,” AIDS Patient Care and STDs, vol. 20, no. 9, pp. 649–657, 2006. View at Publisher · View at Google Scholar · View at Scopus
  16. C. Campbell, B. Williams, and D. Gilgen, “Is social capital a useful conceptual tool for exploring community level influences on HIV infection? An exploratory case study from South Africa,” AIDS Care, vol. 14, no. 1, pp. 41–54, 2002. View at Publisher · View at Google Scholar · View at Scopus
  17. N. K. Janz and M. H. Becker, “The Health Belief Model: a decade later,” Health Education Quarterly, vol. 11, no. 1, pp. 1–47, 1984. View at Scopus
  18. W. N. Mkanta and C. R. Uphold, “Theoretical and methodological issues in conducting research related to health care utilization among individuals with HIV infection,” AIDS Patient Care and STDs, vol. 20, no. 4, pp. 293–303, 2006. View at Publisher · View at Google Scholar · View at Scopus
  19. M. G. Weiss, J. Ramakrishna, and D. Somma, “Health-related stigma: rethinking concepts and interventions,” Psychology, Health and Medicine, vol. 11, no. 3, pp. 277–287, 2006. View at Publisher · View at Google Scholar · View at Scopus
  20. L. M. Bogart, S. Chetty, J. Giddy, et al., “Barriers to care among people living with HIV in South Africa: contrasts between patient and healthcare provider perspectives,” AIDS Care, vol. 25, no. 7, pp. 843–853, 2013.
  21. S. Maman, L. Abler, L. Parker et al., “A comparison of HIV stigma and discrimination in five international sites: the influence of care and treatment resources in high prevalence settings,” Social Science and Medicine, vol. 68, no. 12, pp. 2271–2278, 2009. View at Publisher · View at Google Scholar · View at Scopus
  22. J. N. Sayles, M. D. Wong, J. J. Kinsler, D. Martins, and W. E. Cunningham, “The association of stigma with self-reported access to medical care and antiretroviral therapy adherence in persons living with HIV/AIDS,” Journal of General Internal Medicine, vol. 24, no. 10, pp. 1101–1108, 2009. View at Scopus
  23. L. Beer, J. L. Fagan, E. Valverde, and J. Bertolli, “Health-related beliefs and decisions about accessing HIV medical care among HIV-infected persons who are not receiving care,” AIDS Patient Care and STDs, vol. 23, no. 9, pp. 785–792, 2009. View at Publisher · View at Google Scholar · View at Scopus
  24. L. Moneyham, J. McLeod, A. Boehme et al., “Perceived barriers to HIV care among HIV-infected women in the deep South,” Journal of the Association of Nurses in AIDS Care, vol. 21, no. 6, pp. 467–477, 2010. View at Publisher · View at Google Scholar · View at Scopus
  25. L. Gilbert and L. Walker, “‘My biggest fear was that people would reject me once they knew my status...’: stigma as experienced by patients in an HIV/AIDS clinic in Johannesburg, South Africa,” Health and Social Care in the Community, vol. 18, no. 2, pp. 139–146, 2010. View at Publisher · View at Google Scholar · View at Scopus
  26. L. W. Russ, A. L. Meyerb, L. M. Takahashic, et al., “Examining barriers to care: provider and client perspectives on the stigmatization of HIV-positive Asian Americans with and without viral hepatitis co-infection,” AIDS Care, vol. 24, no. 10, pp. 1302–1307, 2012. View at Publisher · View at Google Scholar
  27. J. Rujumba, S. Neema, R. Byamugisha, T. Tylleskär, J. K. Tumwine, and H. K. Heggenhougen, “‘Telling my husband I have HIV is too heavy to come out of my mouth’: pregnant women's disclosure experiences and support needs following antenatal HIV testing in eastern Uganda,” Journal of the International AIDS Society, vol. 15, no. 2, p. 17429, 2012.
  28. L. Vu, K. Andrinopoulos, C. Mathews, M. Chopra, C. Kendall, and T. P. Eisele, “Disclosure of HIV status to sex partners among HIV-infected men and women in Cape Town, South Africa,” AIDS and Behavior, vol. 16, no. 1, pp. 132–138, 2012. View at Publisher · View at Google Scholar · View at Scopus
  29. M. N. Kimberly, E. B. Susan, J. O. Linda, and M. G. Gary, “Risk of intimate partner violence related to individuals testing HIV positive,” Journal of Public Health Management and Practice, vol. 14, no. 5, p. 498, 2008. View at Scopus
  30. UBOS, Uganda National Household Survey 2009/10, Uganda Bureau of Statistics, Kampala, Uganda, 2010.
  31. M. Skovdal, C. Campbell, C. Nyamukapa, and S. Gregson, “When masculinity interferes with women's treatment of HIV infection: a qualitative study about adherence to antiretroviral therapy in Zimbabwe,” Journal of the International AIDS Society, vol. 14, no. 1, p. 29, 2011. View at Publisher · View at Google Scholar · View at Scopus
  32. ICW, I.C.o.W.o.L.w.H.A., ICW Vision paper 2: Access to Care, treatment and support, 2004.
  33. M. D. Stein, S. Crystal, W. E. Cunningham et al., “Delays in seeking HIV care due to competing caregiver responsibilities,” American Journal of Public Health, vol. 90, no. 7, pp. 1138–1140, 2000. View at Scopus
  34. S. Alina and W. Roberta, Women and Health Care: Key Findings from the Kaiser Women's Health Survey, Kaiser family foundation, Menlo Park, Calif, USA, 2005.
  35. V. H. Raveis, K. Siegel, and E. Gorey, “Factors associated with HIV-infected women's delay in seeking medical care,” AIDS Care, vol. 10, no. 5, pp. 549–562, 1998. View at Publisher · View at Google Scholar · View at Scopus
  36. M. A. Schuster, R. Collins, W. E. Cunningham et al., “Perceived discrimination in clinical care in a nationally representative sample of HIV-infected adults receiving health care,” Journal of General Internal Medicine, vol. 20, no. 9, pp. 807–813, 2005. View at Publisher · View at Google Scholar · View at Scopus
  37. M. A. Lain, M. Valverde, and L. M. Frehill, “Late entry into HIV/AIDS medical care: the importance of past relationships with medical providers,” AIDS Care, vol. 19, no. 2, pp. 190–194, 2007. View at Publisher · View at Google Scholar · View at Scopus
  38. G. M. Wingood, R. J. DiClemente, I. Mikhail et al., “HIV discrimination and the health of women living with HIV,” Women and Health, vol. 46, no. 2-3, pp. 99–112, 2007. View at Publisher · View at Google Scholar · View at Scopus
  39. L. Beer, J. L. Fagan, P. Garland et al., “Medication-related barriers to entering HIV care,” AIDS Patient Care and STDs, vol. 26, no. 4, pp. 214–221, 2012. View at Publisher · View at Google Scholar · View at Scopus
  40. J. R. Finnegan Jr., H. Meischke, J. G. Zapka et al., “Patient delay in seeking care for heart attack symptoms: findings from focus groups conducted in five U.S. regions,” Preventive Medicine, vol. 31, no. 3, pp. 205–213, 2000. View at Publisher · View at Google Scholar · View at Scopus
  41. N. R. Kressin, J. A. Clark, J. Whittle et al., “Racial differences in health-related beliefs, attitudes, and experiences of VA cardiac patients: scale development and application,” Medical Care, vol. 40, supplement 1, pp. I72–I85, 2002. View at Scopus
  42. J. Wanyama, B. Castelnuovo, B. Wandera et al., “Belief in divine healing can be a barrier to antiretroviral therapy adherence in Uganda,” AIDS, vol. 21, no. 11, pp. 1486–1487, 2007. View at Publisher · View at Google Scholar · View at Scopus
  43. E. E. Foley, “HIV/AIDS and African immigrant women in Philadelphia: structural and cultural barriers to care,” AIDS Care, vol. 17, no. 8, pp. 1030–1043, 2005. View at Publisher · View at Google Scholar · View at Scopus
  44. S. Rajabiun, R. K. Mallinson, K. McCoy et al., “‘Getting me back on track’: the role of outreach interventions in engaging and retaining people living with HIV/AIDS in medical care,” AIDS Patient Care and STDs, vol. 21, supplement 1, pp. S20–S29, 2007. View at Publisher · View at Google Scholar · View at Scopus
  45. A. Wringe, M. Roura, M. Urassa, J. Busza, V. Athanas, and B. Zaba, “Doubts, denial and divine intervention: understanding delayed attendance and poor retention rates at a HIV treatment programme in rural Tanzania,” AIDS Care, vol. 21, no. 5, pp. 632–637, 2009. View at Publisher · View at Google Scholar · View at Scopus