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Facilitators and Barriers of Antiretroviral Therapy Initiation among HIV Discordant Couples in Kenya: Qualitative Insights from a Pre-Exposure Prophylaxis Implementation Study.
PLoS One. 2016; 11(12):e0168057.Plos

Abstract

INTRODUCTION

The World Health Organization now recommends antiretroviral therapy (ART) initiation for all HIV-infected individuals regardless of CD4 cell count or disease status. Understanding the facilitators and barriers to initiation of and adherence to ART is essential to successful scale-up of "universal" ART.

METHODS

To investigate facilitators and barriers to ART initiation, we conducted 44 in-depth individual or couple interviews with 63 participants (33 participants with HIV and 30 without HIV) already enrolled in a prospective implementation study of oral antiretroviral-based prevention in Kisumu, Kenya between August and September 2014. A semi-structured interview guided discussions on: 1) perceived advantages and disadvantages of ART; 2) reasons for accepting or declining ART initiation; and 3) influence of prevention of transmission to partner or infant influencing ART use. Transcripts from the interviews were iteratively analyzed using inductive content analysis.

RESULTS

HIV-infected participants indicated that living a healthier life, preventing HIV transmission to others, and appearing "normal" or "healthy" again facilitated their initiation of ART. While appearing "normal" allowed these individuals to interact with their communities without stigmatization, they also perceived community opposition to their initiating ART, because appearing "normal" again prevented community members from easily identifying infected individuals in their community. Denial of diagnosis, disclosure stigma, perceived side-effects, and challenges in obtaining refills were additional barriers to ART initiation.

CONCLUSIONS

Community perceptions play an important role in both facilitating and inhibiting ART initiation. Perceived stigma, including perceived community opposition to widespread ART use, is an important barrier to ART initiation. Addressing such barriers, while capitalizing on facilitators, to ART initiation should be central to universal ART scale-up efforts.

Authors+Show Affiliations

Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, United States of America.Centre for Microbiologic Research, Kenya Medical Research Institute, Kisumu, Kenya.Northwestern University, Chicago, IL, United States of America.School of Medicine, University of California, San Francisco, CA, United States of America.Centre for Microbiologic Research, Kenya Medical Research Institute, Kisumu, Kenya.Centre for Microbiologic Research, Kenya Medical Research Institute, Kisumu, Kenya. Departments of Obstetrics and Gynecology and Global Health, University of Washington, Seattle, WA, United States of America.Departments of Epidemiology, Global Health, and Medicine, University of Washington, Seattle, WA, United States of America.Departments of Epidemiology and Biostatistics and Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, United States of America.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27930740

Citation

Patel, Rena C., et al. "Facilitators and Barriers of Antiretroviral Therapy Initiation Among HIV Discordant Couples in Kenya: Qualitative Insights From a Pre-Exposure Prophylaxis Implementation Study." PloS One, vol. 11, no. 12, 2016, pp. e0168057.
Patel RC, Odoyo J, Anand K, et al. Facilitators and Barriers of Antiretroviral Therapy Initiation among HIV Discordant Couples in Kenya: Qualitative Insights from a Pre-Exposure Prophylaxis Implementation Study. PLoS ONE. 2016;11(12):e0168057.
Patel, R. C., Odoyo, J., Anand, K., Stanford-Moore, G., Wakhungu, I., Bukusi, E. A., Baeten, J. M., & Brown, J. M. (2016). Facilitators and Barriers of Antiretroviral Therapy Initiation among HIV Discordant Couples in Kenya: Qualitative Insights from a Pre-Exposure Prophylaxis Implementation Study. PloS One, 11(12), e0168057. https://doi.org/10.1371/journal.pone.0168057
Patel RC, et al. Facilitators and Barriers of Antiretroviral Therapy Initiation Among HIV Discordant Couples in Kenya: Qualitative Insights From a Pre-Exposure Prophylaxis Implementation Study. PLoS ONE. 2016;11(12):e0168057. PubMed PMID: 27930740.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Facilitators and Barriers of Antiretroviral Therapy Initiation among HIV Discordant Couples in Kenya: Qualitative Insights from a Pre-Exposure Prophylaxis Implementation Study. AU - Patel,Rena C, AU - Odoyo,Josephine, AU - Anand,Keerthana, AU - Stanford-Moore,Gaelen, AU - Wakhungu,Imeldah, AU - Bukusi,Elizabeth A, AU - Baeten,Jared M, AU - Brown,Joelle M, Y1 - 2016/12/08/ PY - 2016/08/31/received PY - 2016/11/25/accepted PY - 2016/12/9/entrez PY - 2016/12/9/pubmed PY - 2017/7/19/medline SP - e0168057 EP - e0168057 JF - PloS one JO - PLoS ONE VL - 11 IS - 12 N2 - INTRODUCTION: The World Health Organization now recommends antiretroviral therapy (ART) initiation for all HIV-infected individuals regardless of CD4 cell count or disease status. Understanding the facilitators and barriers to initiation of and adherence to ART is essential to successful scale-up of "universal" ART. METHODS: To investigate facilitators and barriers to ART initiation, we conducted 44 in-depth individual or couple interviews with 63 participants (33 participants with HIV and 30 without HIV) already enrolled in a prospective implementation study of oral antiretroviral-based prevention in Kisumu, Kenya between August and September 2014. A semi-structured interview guided discussions on: 1) perceived advantages and disadvantages of ART; 2) reasons for accepting or declining ART initiation; and 3) influence of prevention of transmission to partner or infant influencing ART use. Transcripts from the interviews were iteratively analyzed using inductive content analysis. RESULTS: HIV-infected participants indicated that living a healthier life, preventing HIV transmission to others, and appearing "normal" or "healthy" again facilitated their initiation of ART. While appearing "normal" allowed these individuals to interact with their communities without stigmatization, they also perceived community opposition to their initiating ART, because appearing "normal" again prevented community members from easily identifying infected individuals in their community. Denial of diagnosis, disclosure stigma, perceived side-effects, and challenges in obtaining refills were additional barriers to ART initiation. CONCLUSIONS: Community perceptions play an important role in both facilitating and inhibiting ART initiation. Perceived stigma, including perceived community opposition to widespread ART use, is an important barrier to ART initiation. Addressing such barriers, while capitalizing on facilitators, to ART initiation should be central to universal ART scale-up efforts. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/27930740/Facilitators_and_Barriers_of_Antiretroviral_Therapy_Initiation_among_HIV_Discordant_Couples_in_Kenya:_Qualitative_Insights_from_a_Pre_Exposure_Prophylaxis_Implementation_Study_ L2 - http://dx.plos.org/10.1371/journal.pone.0168057 DB - PRIME DP - Unbound Medicine ER -