Barriers to Utilization of HIV Care Services Among Adolescents and Young Adults in Rakai, Uganda: the Role of Economic Strengthening

Nakigozi, Gertrude; Makumbi, Fredrick; Kigozi, Godfrey; Nalugoda, Fred; Reynolds, Steven J.; Chang, Larry W.; Kagaayi, Joseph; Serwadda, David; Wawer, Maria J.; Gray, Ronald H.

doi:10.1007/s40609-015-0030-4

Cited by 11 publications

(10 citation statements)

References 30 publications

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“…We found that women and PLHIV on ART were more likely to return to HIV care after missing a scheduled clinic visit. This finding is in agreement with prior studies in which gender and ART status were associated with return to care after tracking [ 16 , 20 – 22 ]. In a systematic review of 42 studies from 12 countries, factors associated with lower retention rates included younger age, male gender, stigma, non-disclosure of HIV status, fear of drug side effects, and transport costs [ 23 ].…”

Section: Main Textsupporting

confidence: 93%

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Re-engagement in HIV care following a missed visit in rural Uganda

et al. 2018

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ObjectiveWe conducted a retrospective cohort study to assess the effect of tracking People Living with HIV (PLHIV) after missed clinic visits and factors associated with return to care in rural Uganda. We assessed retention in care among 650 HIV-infected women and men. We used univariable and multivariable generalized linear models to assess demographic and self-reported factors associated with re-engagement in HIV care.ResultsOf 381 PLHIV who ever missed a scheduled appointment, 68% were female and most (80%) had initiated ART. Most (70%) of those tracked returned to care. Relative to men, women (adjusted risk ratio [ARR] 1.23; 95% confidence interval (CI) 1.05–1.43; p = 0.009) were more likely to return to care after active tracking. PLHIV who missed scheduled visits for other reasons (forgetting, adequate drug supplies, or long distance to clinic) had reduced odds of return to care (ARR 0.41; 95% CI 0.28–0.59; p < 0.001). These data support close monitoring of patient retention in HIV care and active measures to re-engage those who miss an appointment. Furthermore, they highlight the need for targeted interventions to those more resistant to re-engagement such as men.

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Section: Main Textsupporting

confidence: 93%

“…The proportion of PLHIV who ever missed a scheduled clinic visit in our study is similar to that reported in other studies of mobile populations [ 15 , 16 , 22 ]. Some PLHIV may have cycled in and out of care, given the mobile nature of the study population [ 9 ].…”

Section: Main Textsupporting

confidence: 90%

Re-engagement in HIV care following a missed visit in rural Uganda

et al. 2018

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“…They were unable to meet the financial demands of transport, which made making a walk to the clinic a necessary. Similar findings related to transport issues were reported in other countries such as Uganda (Nakigozi et al, 2015). In resource‐rich countries such as the United States of America (USA) and Australia, specific disadvantaged groups of YLWHIV are often impacted with similar issues, mainly those living in poverty, in society with a limited number of services and without adequate health insurance coverages (Centers for Disease Control & Prevention, 2020, Lea et al, 2019).…”

Section: Discussionsupporting

confidence: 88%

“…Despite the efforts above, SSA countries continue to lack the means of maintaining sufficient utilization and accessibility to these services by their youth population (Akatukwasa et al, 2019). Stigma, lack of confidentiality, inherent poverty, poor clinical reception, lack of governments’ protection against child abuse and societal misconception about sexual reproductive health services, have all been reported in SSA as barriers to service access and utilization (Nakigozi et al, 2015, Sullivan et al, 2019). The under‐utilization of the provided services negatively impacts on HIV knowledge, access to condoms and ART adherence for controlling HIV transmission (Rodger et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

Uptake of health services by youth living with HIV: a focused ethnography

Zgambo

Arabiat

Ireson

2020

International Nursing Review

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Background Although several programs have been initiated to increase the uptake of health services amongst youth living with human immunodeficiency virus in the world, disparities in access to these care services still exist. Aim This study aimed to explore the experiences of young people as they attend the human immunodeficiency virus clinic and to identify factors affecting their uptake of health services in southern Malawi. Methods A focused ethnography was conducted to collect data from 20 youths living with human immunodeficiency virus and aged between 15 and 24 years through one‐on‐one in‐depth interviews and casual observations. The interviews data were analysed thematically following transcriptions. Findings Two themes emerged to describe the factors that facilitated or hindered the uptake of HIV‐health services. The first theme: Facilitators to the accessibility and utilization of HIV services consisted subthemes of Health personnel‐related factors and Innovative healthcare delivery approach. The second theme: Barriers to utilization and accessibility of HIV service comprised of the following subthemes: Ignorance of health services available, Clinic‐related factors and Consumer‐related factors. Conclusion Efforts to support health services that are youth‐friendly and easily accessible are needed to increase uptake, decrease mortality, prevent disability and promote the wellbeing of youth living with human immunodeficiency virus. Implications for nursing practice and policy Approaches used with this population should be youth‐centred and multifaceted, recognizing both the psychosocial challenges and the vulnerability that many youths in Malawi experience.

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“…Moreover, other factors that act as barriers for adolescent HIV testing uptake include poor accessibility to HTS due to transport, cost, service hours of health facilities, and negative attitudes or behaviors from health providers, including being judgmental and not maintaining confidentiality [ 17 , 18 ]. On a structural level, consent requirements pose barriers for adolescents in accessing testing services.…”

Section: Introductionmentioning

confidence: 99%

“When you have a high life, and you like sex, you will be afraid”: a qualitative evaluation of adolescents’ decision to test for HIV in Zambia and Kenya using the health belief model

Katirayi

Akuno²,

Kulukulu

et al. 2021

BMC Public Health

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Background HIV testing among adolescents is significantly lower than among adults and many adolescents living with HIV do not know their status. Adolescent perceptions of HIV testing are poorly understood and may negatively affect testing uptake. Using a qualitative design, this study sought to explore perceptions about HIV testing and treatment among adolescents living with HIV and adolescents of unknown HIV status in Lusaka, Zambia and Kenya. Methods Study participants were adolescents aged 15–19 years old. The adolescents living with HIV were recruited from HIV support groups at health facilities. Adolescents of unknown HIV status were recruited from existing adolescent groups within the community. In both Zambia and Kenya, four focus group discussions (FGDs) were conducted with adolescents living with HIV and four FGDs were conducted with adolescents whose HIV status was unknown, for a total of 16 FDGs. FGDs consisted of 6–12 participants, a moderator, and a note-taker. FGDs were audio-recorded, transcribed, and translated into transcripts. Transcripts were coded in the qualitative analysis software program MAXQDA v. 12. Data reduction and summary tables were generated to help identify themes across the two study population groups. Data were interpreted within the health belief model. Results Adolescents discussed the challenges of facing a positive HIV test result, including fear of a positive result and need to change their lifestyle, fear of social isolation, and perception of the lost opportunity to achieve future dreams. Most adolescents of unknown status were not as aware of the benefits of learning their HIV status, nor were they aware of the ability to live a long and healthy life on ART. HIV-positive adolescents reported that the messages targeted towards adolescents focus on the need to remain HIV-negative, as opposed to the benefits of knowing one’s status. Adolescents described age and requirements for parental permission as a significant limitation in their ability to access HIV testing. Conclusions Adolescents require more information about the benefits of testing early and the ability to live a long and healthy life on ART. Educating adolescents that HIV testing is a normative behavior among their peers could strengthen HIV testing among adolescents.

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Barriers to Utilization of HIV Care Services Among Adolescents and Young Adults in Rakai, Uganda: the Role of Economic Strengthening

Cited by 11 publications

References 30 publications

Re-engagement in HIV care following a missed visit in rural Uganda

Re-engagement in HIV care following a missed visit in rural Uganda

Uptake of health services by youth living with HIV: a focused ethnography

“When you have a high life, and you like sex, you will be afraid”: a qualitative evaluation of adolescents’ decision to test for HIV in Zambia and Kenya using the health belief model

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