“That makes me feel human”: a qualitative evaluation of the acceptability of an HIV differentiated care intervention for formerly incarcerated people re-entering community settings in South Africa

Abstract

Background Correctional settings in South Africa have disproportionately high rates of HIV infection; a large number of inmates living with HIV return to the community each year. The transition community adherence club (TCAC) intervention was a differentiated care delivery approach with structural and peer components designed to increase antiretroviral therapy (ART) adherence and HIV care engagement following release from incarceration. The objective of this study was to assess the acceptability of the TCAC intervention among HIV-infected community re-entrants to inform program revisions and future intervention designs. Methods This was a qualitative study set within a randomized controlled trial (RCT) of the TCAC intervention in South Africa. We conducted semi-structured, in-depth interviews with 16 re-entrants living with HIV and assigned to the intervention arm. All interviews were audio-recorded, transcribed, translated, and de-identified. Transcripts were coded and analyzed using content analysis, and acceptability was assessed using the Theoretical Framework of Acceptability (TFA). Results Overall, study participants reported that the TCAC intervention was acceptable. Development of supportive relationships between participants, non-judgmental attitudes from peer-facilitators, and perceived effectiveness of the intervention to support ART adherence and HIV care were noted as the most valued components. An altruistic desire to help other participants facing similar post-incarceration and HIV-related challenges was a key motivator for TCAC attendance. A lack of access to reliable transportation to intervention sites and clinic-based medication collection were described as burdens to program participation. Illicit drug use by other group members and negative social influences were also identified as potential barriers to optimal program engagement. Conclusion The TCAC was a well-accepted model of differentiated care delivery among re-entrants living with HIV in South Africa. To further enhance intervention acceptability for future scale-ups, program revisions should address logistical barriers related to reaching TCAC sites and implementing ART distribution at TCAC group sessions.

Experiences of Justice-Involved People Transitioning to HIV Care in the Community After Prison Release in Lusaka, Zambia: A Qualitative Study

“…Third, similar to findings from the United States, our study suggests a potential role for prerelease discharge planning, case management, and peer-navigation support systems to assess releasees' subsistence, psychosocial, and medical needs, as well as to help justice-involved PLHIV develop problem-solving skills and understand their HIV care and medical history. 25,30,34,[54][55][56][57][58][59][60] While acceptability studies evaluating differentiated care delivery models for justice-involved PLHIV in South Africa 61 show promise, how such approaches could be adapted for and implemented within the Zambian correctional context requires further exploration.…”

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“…However, given findings of successful recruitment but high attrition, it was felt that using a focused, structured approach to understand the acceptability, of both the trial processes and experience of the ACT group, would enable identification of specific areas to be addressed in future work. The TFA has been applied in this way to various interventions, including a men’s mental health promotion program [ 48 ] a digital return to work intervention for common mental disorders [ 49 ] and an HIV differentiated care intervention for formerly incarcerated people re-entering community settings [ 50 ]. Its use therefore enhances the applicability of study findings by structuring findings according to recognised constructs of acceptability.…”