“They come and knock at the gate until the neighbours see”. Perceived barriers and benefits of implementing HIV care at the community level in Tshwane district: A qualitative study

Abstract

Little is known about the barriers and benefits of home-based HIV services offered by community health workers. These are especially important as the South African government embarks on scaling up community-based health services, which include HIV care. This study set out to understand potential benefits and barriers of these services in Tshwane district and develop recommendations for improvement. From June to August 2019, seven focus group discussions were conducted with 58 participants: four with 36 ward-based outreach team (WBOT) members and three with 22 people living with HIV (PLWHIV). Three aspects of care were explored: 1. Experience of performing, receiving or observing homebased HIV care; 2. Barriers to conducting home visits; and 3. The perceived value of WBOTs and home-based HIV care. While home-based HIV care was seen as a support strategy which could motivate patients to take their medication, the unpredictability of patients' responses to HIV test results, incorrect addresses (driven by the need for identity documents), fear of stigma through association with WBOTs, especially those in uniform, little or no preparation of patients for home-based care, and lack of confidentiality and trust were raised as potential barriers. To successfully implement effective home-based HIV care in South Africa, perceived barriers should be addressed and recommendations offered by people providing and receiving these services should be seriously considered. Pertinent recommendations include integrating WBOTs into clinics and existing support structures, improving training on confidentiality and HIV testing, and rethinking the recruitment, scope of work and safety of WBOTs. In addition, research should be conducted into the impact of the requirements for identity documents and community health worker uniforms.

Knowledge and Perceptions of People Living With HIV Regarding The HIV Services That Are Offered By The Community Health Workers in KwaZulu-Natal, South Africa

“…This nding is consistent with other studies that were conducted in KZN and South Africa [11,[37][38][39] ]. Perceptions of poor con dentiality has diminished trust towards CHWs and have been associated with negative attitudes and low acceptance of this cadre [11,[37][38][39] . Furthermore, the communities in KZN have been reported to disrespect CHWs and have a perception that they lack professionalism compared to professional nurses [40] .…”

“…Negative perceptions towards HIV services offered by CHWs were due to the idea that CHWs are not well educated, are not well informed about HIV but mostly that they lacked con dentiality. This nding is consistent with other studies that were conducted in KZN and South Africa [11,[37][38][39] ]. Perceptions of poor con dentiality has diminished trust towards CHWs and have been associated with negative attitudes and low acceptance of this cadre [11,[37][38][39] .…”

Acceptability of Home-Based HIV Care Offered by Community Health Workers in Tshwane District, South Africa: A Survey

“…This demonstrates that there is significant support for this intervention, but that specific issues need to be addressed to make the intervention acceptable to all. Although some PLWHIV view visits by CHWs as attracting unnecessary attention from community members, 9 results of this study show that the vast majority (close to 90%) of participants want to be visited by CHWs. Importantly, however, ±28% of participants did not want CHWs to visit them with branded cars, whereas ±16% did not want CHWs to wear uniforms.…”

“…The questionnaire was designed based on the themes that had emerged from the focus group discussions during the prior study. 9 The questionnaire covered sociodemographic information, the role of CHWs, CHW services, HIV status disclosure, and CHW home visits. The questionnaire was piloted in one of the sites among 20 PLWHIV and minor changes were made to improve the comprehension of some questions.…”

“…This study is an extension of a qualitative study that looked at perceived barriers and benefits (by WBPHCOTs and PLWHIV) of implementing HIV care at the community level in Tshwane district. 9 The aim of this study was to assess the acceptability of community-based HIV services offered by CHWs to PLWHIV.…”