Towards 90-90-90 Target: Factors Influencing Availability, Access, and Utilization of HIV Services—A Qualitative Study in 19 Ugandan Districts

Abstract

Background UNAIDS has set a new target 90-90-90 by 2020. To achieve this target, current programs need to address challenges that limit access, availability, and utilization of HIV testing and treatment services. Therefore, the aim of this study was to identify the barriers that influence access, availability, and utilization of HIV services in rural Uganda within the setting of a large donor funded program. Methods We conducted key informant interviews with stakeholders at the district level, staff of existing HIV/AIDS projects, and health facilities in 19 districts. Data were also collected from focus group discussions comprised of clients presenting for HIV care and treatment. Data were transcribed and analyzed using content analysis. Results. Barriers identified were as follows: (1) drug shortages including antiretroviral drugs at health facilities. Some patients were afraid to start ART because of worrying about shortages; (2) distance and (3) staffing shortages; (4) stigma persistence; (5) lack of social and economic support initiatives that enhance retention in treatment. Conclusions In conclusion, our study has identified several factors that influence access, availability, and utilization of HIV services. Programs need to address drug and staff shortages, HIV stigma, and long distances to health facilities to broaden access and utilization in order to realize the UNAIDS target.

ART use and associated factors among HIV positive caregivers of orphans and vulnerable children in Tanzania

“…This observation remained significant in the stratified analysis for both female and male caregivers. This observation is consistent with many others which have established that lack of food is a significant barrier to ART utilization and adherence [14,55,[58][59][60]. People may be hesitant to start ART if they do not intend to stay on it due to such reasons as lack of food.…”

“…These disparities in ART use between male and female caregivers in the middle through fifth wealth quintiles were not clear, thus a need for further research to clarify the observed relationship. Overall, other studies have observed higher likelihood of ART use with better economic status [7,14,57,58,69].…”

“…Therefore, the presence of disability and disease can lead nondisabled to avoid contact with the disabled or even to engage in making antisocial comments or actions [67]. This, in most cases, results into self-stigma [68], a phenomenon that has been associated with poor use of ART in PLHIV [7,14,15].…”

“…Barriers to ART access and use among PLHIV in developing countries have been well documented. The most commonly cited barriers to ART use among PLHIV in the developing world are stigma and the distance between place of residence and the health facility [7,[12][13][14][15]. Also, lower ART coverage among men than women (68% vs. 71%), and among youth under 30 years than those aged 30-59 years (58% vs. 75%) were observed in KwaZulu-Natal, South Africa, implying that sex and age are important demographic factors playing a role in ART coverage [16].…”

“…Furthermore, a recent qualitative systematic review in low-and middle-income countries (LMICs) observed the following reasons for ART nonuse: feeling healthy, low social support, gender norms, difficulties translating intentions into actions, high care-seeking costs, concerns about confidentiality, low quality health services, recommended lifestyle changes, and incomplete knowledge of treatment benefits [7]. Similarly, barriers to ART access in terms of fear to start ART due to drug shortages at health facilities, staffing shortages, and lack of social and economic support were identified in Uganda [14], as well as fear of HIV disclosure, women's lack of support from male partners, demanding work schedules, and high transport costs [15]. Male gender, younger age, living alone or in households with one to two co-residents, and CD4 count of more than 250 cells per microliter of blood were significantly associated with non-enrollment into free community HIV care in Uganda [17].…”