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

Florence Mwangwa, Monica Getahun, Harriet Itiakorit, Vivek Jain, James Ayieko, Lawrence Owino, Cecilia Akatukwasa, Irene Maeri, Catherine A Koss, Gabriel Chamie, Tamara D Clark, Jane Kabami, Mucunguzi Atukunda, Dalsone Kwarisiima, Norton Sang, Elizabeth A Bukusi, Moses R Kamya, Maya L Petersen, Craig R Cohen, Edwin D Charlebois, Diane V Havlir, Carol S Camlin, Florence Mwangwa, Monica Getahun, Harriet Itiakorit, Vivek Jain, James Ayieko, Lawrence Owino, Cecilia Akatukwasa, Irene Maeri, Catherine A Koss, Gabriel Chamie, Tamara D Clark, Jane Kabami, Mucunguzi Atukunda, Dalsone Kwarisiima, Norton Sang, Elizabeth A Bukusi, Moses R Kamya, Maya L Petersen, Craig R Cohen, Edwin D Charlebois, Diane V Havlir, Carol S Camlin

Abstract

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://ichgcp.net/clinical-trials-registry/NCT01864603.

Keywords: HIV care; care linkage; differentiated service delivery; patient-centered care; rapid ART; viral load counseling; viral suppression.

Conflict of interest statement

Declaration of Conflicting Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Building blocks: SEARCH streamlined care model. Visually adapted content.,.

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