How early is too early? Challenges in ART initiation and engaging in HIV care under Treat All in Rwanda-A qualitative study.
Adult
Anti-HIV Agents
/ therapeutic use
Female
Focus Groups
HIV Infections
/ diagnosis
Health Knowledge, Attitudes, Practice
Humans
Longitudinal Studies
Male
Patient Acceptance of Health Care
/ psychology
Practice Guidelines as Topic
Qualitative Research
Rwanda
/ epidemiology
Social Stigma
Time-to-Treatment
/ standards
Young Adult
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2021
2021
Historique:
received:
04
09
2020
accepted:
29
04
2021
entrez:
13
5
2021
pubmed:
14
5
2021
medline:
25
2
2023
Statut:
epublish
Résumé
HIV treatment guidelines recommend that all people living with HIV (PLWH) initiate antiretroviral therapy (ART) as soon as possible after diagnosis (Treat All). As Treat All is more widely implemented, an increasing proportion of PLWH are likely to initiate ART when they are asymptomatic, and they may view the relative benefits and risks of ART differently than those initiating at more advanced disease stages. To date, patient perspectives of initiating care under Treat All in sub-Saharan Africa have not been well described. From September 2018 to March 2019, we conducted individual, semi-structured, qualitative interviews with 37 patients receiving HIV care in two health centers in Kigali, Rwanda. Data were analyzed using a mixed deductive and inductive thematic analysis approach to describe perceived barriers to, facilitators of and acceptability of initiating and adhering to ART rapidly under Treat All. Of 37 participants, 27 were women and the median age was 31 years. Participants described feeling traumatized and overwhelmed by their HIV diagnosis, resulting in difficulty accepting their HIV status. Most were prescribed ART soon after diagnosis, yet fear of lifelong medication and severe side effects in the immediate period after initiating ART led to challenges adhering to therapy. Moreover, because many PLWH initiated ART while healthy, taking medications and attending appointments were visible signals of HIV status and highly stigmatizing. Nonetheless, many participants expressed enthusiasm for Treat All as a program that improved health as well as health equity. For newly-diagnosed PLWH in Rwanda, initiating ART rapidly under Treat All presents logistical and emotional challenges despite the perceived benefits. Our findings suggest that optimizing early engagement in HIV care under Treat All requires early and ongoing intervention to reduce trauma and stigma, and promote both individual and community benefits of ART.
Identifiants
pubmed: 33984044
doi: 10.1371/journal.pone.0251645
pii: PONE-D-20-27888
pmc: PMC8118273
doi:
Substances chimiques
Anti-HIV Agents
0
Types de publication
Journal Article
Multicenter Study
Observational Study
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0251645Subventions
Organisme : NIMH NIH HHS
ID : K23 MH114752
Pays : United States
Organisme : NIAID NIH HHS
ID : P30 AI124414
Pays : United States
Organisme : NIAID NIH HHS
ID : U01 AI096299
Pays : United States
Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
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