A qualitative study of barriers to enrollment into free HIV care

Perspectives of never-in-care HIV-positive patients and providers in Rakai, Uganda

Gertrude Nakigozi, Lynn Atuyambe, Moses Kamya, Fredrick E. Makumbi, Larry Chang, Neema Nakyanjo, Godfrey Kigozi, Fred Nalugoda, Valerian Kiggundu, David Serwadda, Maria J Wawer, Ronald H Gray

Research output: Contribution to journalArticle

Abstract

Background. Early entry into HIV care is low in Sub-Saharan Africa. In Rakai, about a third (31.5%) of HIV-positive clients who knew their serostatus did not enroll into free care services. This qualitative study explored barriers to entry into care from HIV-positive clients who had never enrolled in care and HIV care providers. Methods. We conducted 48 in-depth interviews among HIV-infected individuals aged 15-49 years, who had not entered care within six months of result receipt and referral for free care. Key-informant interviews were conducted with 12 providers. Interviews were audio-recorded and transcripts subjected to thematic content analysis based on the health belief model. Results. Barriers to using HIV care included fear of stigma and HIV disclosure, women's lack of support from male partners, demanding work schedules, and high transport costs. Programmatic barriers included fear of antiretroviral drug side effects, long waiting and travel times, and inadequate staff respect for patients. Denial of HIV status, belief in spiritual healing, and absence of AIDS symptoms were also barriers. Conclusion. Targeted interventions to combat stigma, strengthen couple counseling and health education programs, address gender inequalities, and implement patient-friendly and flexible clinic service hours are needed to address barriers to HIV care.

Original languageEnglish (US)
Article number470245
JournalBioMed Research International
Volume2013
DOIs
StatePublished - 2013

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Uganda
Health
HIV
Travel time
Education
Pharmaceutical Preparations
Interviews
Costs
Fear
Spiritual Therapies
Africa South of the Sahara
Disclosure
Drug-Related Side Effects and Adverse Reactions
Health Education
Counseling
Appointments and Schedules
Acquired Immunodeficiency Syndrome
Referral and Consultation
Costs and Cost Analysis

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Immunology and Microbiology(all)
  • Medicine(all)

Cite this

A qualitative study of barriers to enrollment into free HIV care : Perspectives of never-in-care HIV-positive patients and providers in Rakai, Uganda. / Nakigozi, Gertrude; Atuyambe, Lynn; Kamya, Moses; Makumbi, Fredrick E.; Chang, Larry; Nakyanjo, Neema; Kigozi, Godfrey; Nalugoda, Fred; Kiggundu, Valerian; Serwadda, David; Wawer, Maria J; Gray, Ronald H.

In: BioMed Research International, Vol. 2013, 470245, 2013.

Research output: Contribution to journalArticle

Nakigozi, Gertrude ; Atuyambe, Lynn ; Kamya, Moses ; Makumbi, Fredrick E. ; Chang, Larry ; Nakyanjo, Neema ; Kigozi, Godfrey ; Nalugoda, Fred ; Kiggundu, Valerian ; Serwadda, David ; Wawer, Maria J ; Gray, Ronald H. / A qualitative study of barriers to enrollment into free HIV care : Perspectives of never-in-care HIV-positive patients and providers in Rakai, Uganda. In: BioMed Research International. 2013 ; Vol. 2013.
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