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Barriers and facilitators to the uptake of Test and Treat in Mozambique : a qualitative study on patient and provider perceptions

(2018) PLOS ONE. 13(12).
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Abstract
Background In mid-2016, Mozambique began phased implementation of the 'Test-and-Treat' policy, which enrolls HIV positive clients into antiretroviral treatment (ART) immediately regardless of CD4 cell count or disease stage. Novel insights into barriers and facilitators to ART initiation among healthy clients are needed to improve implementation of Test and Treat. Methods and findings A cross-sectional qualitative study was conducted across 10 health facilities in Mozambique. In-depth interviews (IDIs) were conducted with HIV-positive clients (60 who initiated/20 who did not initiate ART within Test and Treat) and 9 focus group discussion (FGDs) were conducted with health care workers (HCWs; n = 53). Data were analyzed using deductive and inductive analysis strategies. Barriers to ART initiation included: (1) feeling 'healthy'; (2) not prepared to start ART for life; (3) concerns about ART side effects; (4) fear of HIV disclosure and discrimination; (5) poor interactions with HCWs; (6) limited privacy at health facilities; and (7) perceptions of long wait times. Facilitators included the motivation to stay healthy and to take care of dependents, as well as new models of ART services such as adaptation of counseling to clients' specific needs, efficient patient flow, and integrated HIV/primary care services. Conclusions ART initiation may be difficult for healthy clients in the context of Test-and-Treat. Specific strategies to engage this population are needed. Strategies could include targeted support for clients, community sensitization on the benefits of early ART initiation, client-centered approaches to patient care, and improved efficiency through multi-month scripting and increased workforce.
Keywords
SUB-SAHARAN AFRICA, HIV CARE CONTINUUM, OPTION B PLUS, ANTIRETROVIRAL, THERAPY, FOLLOW-UP, RISK-FACTORS, HEALTH-CARE, ENGAGEMENT, RETENTION, LINKAGE

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MLA
Nhassengo, Pedroso, et al. “Barriers and Facilitators to the Uptake of Test and Treat in Mozambique : A Qualitative Study on Patient and Provider Perceptions.” PLOS ONE, vol. 13, no. 12, Public Library Science, 2018, doi:10.1371/journal.pone.0205919.
APA
Nhassengo, P., Cataldo, F., Magaco, A., Hoffman, R. M., Nerua, L., Saide, M., … Dovel, K. (2018). Barriers and facilitators to the uptake of Test and Treat in Mozambique : a qualitative study on patient and provider perceptions. PLOS ONE, 13(12). https://doi.org/10.1371/journal.pone.0205919
Chicago author-date
Nhassengo, Pedroso, Fabian Cataldo, Amilcar Magaco, Risa M. Hoffman, Lucas Nerua, Mohomede Saide, Rosa Marlene Manjate, et al. 2018. “Barriers and Facilitators to the Uptake of Test and Treat in Mozambique : A Qualitative Study on Patient and Provider Perceptions.” PLOS ONE 13 (12). https://doi.org/10.1371/journal.pone.0205919.
Chicago author-date (all authors)
Nhassengo, Pedroso, Fabian Cataldo, Amilcar Magaco, Risa M. Hoffman, Lucas Nerua, Mohomede Saide, Rosa Marlene Manjate, Roxanne Hoek, Francisco Mbofana, Aleny Couto, Eduardo Gudo, Sergio Chicumbe, and Kathryn Dovel. 2018. “Barriers and Facilitators to the Uptake of Test and Treat in Mozambique : A Qualitative Study on Patient and Provider Perceptions.” PLOS ONE 13 (12). doi:10.1371/journal.pone.0205919.
Vancouver
1.
Nhassengo P, Cataldo F, Magaco A, Hoffman RM, Nerua L, Saide M, et al. Barriers and facilitators to the uptake of Test and Treat in Mozambique : a qualitative study on patient and provider perceptions. PLOS ONE. 2018;13(12).
IEEE
[1]
P. Nhassengo et al., “Barriers and facilitators to the uptake of Test and Treat in Mozambique : a qualitative study on patient and provider perceptions,” PLOS ONE, vol. 13, no. 12, 2018.
@article{8671295,
  abstract     = {Background In mid-2016, Mozambique began phased implementation of the 'Test-and-Treat' policy, which enrolls HIV positive clients into antiretroviral treatment (ART) immediately regardless of CD4 cell count or disease stage. Novel insights into barriers and facilitators to ART initiation among healthy clients are needed to improve implementation of Test and Treat. Methods and findings A cross-sectional qualitative study was conducted across 10 health facilities in Mozambique. In-depth interviews (IDIs) were conducted with HIV-positive clients (60 who initiated/20 who did not initiate ART within Test and Treat) and 9 focus group discussion (FGDs) were conducted with health care workers (HCWs; n = 53). Data were analyzed using deductive and inductive analysis strategies. Barriers to ART initiation included: (1) feeling 'healthy'; (2) not prepared to start ART for life; (3) concerns about ART side effects; (4) fear of HIV disclosure and discrimination; (5) poor interactions with HCWs; (6) limited privacy at health facilities; and (7) perceptions of long wait times. Facilitators included the motivation to stay healthy and to take care of dependents, as well as new models of ART services such as adaptation of counseling to clients' specific needs, efficient patient flow, and integrated HIV/primary care services. Conclusions ART initiation may be difficult for healthy clients in the context of Test-and-Treat. Specific strategies to engage this population are needed. Strategies could include targeted support for clients, community sensitization on the benefits of early ART initiation, client-centered approaches to patient care, and improved efficiency through multi-month scripting and increased workforce.},
  articleno    = {e0205919},
  author       = {Nhassengo, Pedroso and Cataldo, Fabian and Magaco, Amilcar and Hoffman, Risa M. and Nerua, Lucas and Saide, Mohomede and Manjate, Rosa Marlene and Hoek, Roxanne and Mbofana, Francisco and Couto, Aleny and Gudo, Eduardo and Chicumbe, Sergio and Dovel, Kathryn},
  issn         = {1932-6203},
  journal      = {PLOS ONE},
  keywords     = {SUB-SAHARAN AFRICA,HIV CARE CONTINUUM,OPTION B PLUS,ANTIRETROVIRAL,THERAPY,FOLLOW-UP,RISK-FACTORS,HEALTH-CARE,ENGAGEMENT,RETENTION,LINKAGE},
  language     = {eng},
  number       = {12},
  pages        = {17},
  publisher    = {Public Library Science},
  title        = {Barriers and facilitators to the uptake of Test and Treat in Mozambique : a qualitative study on patient and provider perceptions},
  url          = {http://dx.doi.org/10.1371/journal.pone.0205919},
  volume       = {13},
  year         = {2018},
}

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