Understanding factors influencing utilization of HIV prevention and treatment services among patients and providers in a heterogeneous setting: A qualitative study from South Africa

Abstract

Despite advances made in HIV prevention and treatment interventions in South Africa, barriers to their utilization continue to exist. Understanding perspectives from patients and providers of healthcare can shed light on the necessary strategies to enhance uptake of HIV services. A cross-sectional qualitative study was conducted in July 2020 in Ekurhuleni District. Based on HIV prevalence estimates from a national survey, male condom use coverage and antiretroviral treatment (ART) initiation rates from routinely collected clinical data for 2012, we selected facilities from geographical areas with varying HIV prevalence and uptake of HIV services. In-depth interviews were conducted with adult (≥18 years) patients and healthcare workers in selected primary healthcare facilities. Thematic analysis was performed following a framework built around the social cognitive theory to describe behavioural, personal, and social/environmental factors influencing utilization of HIV services. Behavioural factors facilitating uptake of HIV services included awareness of the protective value of condoms, and the benefits of ART in suppressing viral load and preventing mother-to-child HIV transmission which was evident across geographical areas. Barriers in high prevalence areas included suboptimal condom use, fears of a positive HIV result, and anticipated HIV-related stigma while seeking healthcare services. Across the geographical areas, personal factors included ability to correctly use available services enhanced by knowledge acquired during counselling sessions and community-based health promotion activities. Further, social support from family reinforced engagement in care. Compared to low uptake areas, clinics in high uptake areas used care-facilitators, outreach teams and decanting programs to address the environmental barriers including staff shortages and long queues. Barriers at multiple levels prevent optimal utilization of HIV services, calling for strategies that target and address the different levels and tailored to needs of specific settings. Overall, improved delivery of HIV prevention or treatment interventions can be achieved through strengthening training of healthcare providers in facilities and communities and addressing negative sequelae from utilising services in low uptake areas.

Public health services and intersectional stigma: a social sciences perspective with implications for HIV service design and delivery

“…Anticipated stigma typically refers to expectations of prejudice or discrimination in health services, while internalized stigma typically refers to one's own belief in negative ideas around one's stigmatized identity [21]. Recent work continues to highlight how such forms of stigma create barriers towards linkage to health services [24,25], and lead to difficulties among patients in sustaining their engagement in HIV health services [26][27][28].…”

Healthcare practitioners and students’ PEP knowledge, attitude and adherence in Southern Africa

“…This case would assist in knowledge sharing and adherence if information about PEP was already publicised. Although the more significant majority completed the course of the PEP treatment, a high number of HCPs does not finish treatment because of several reasons that are somewhat justified (Aigbodion et al 2019 ; Bareki & Tenego 2018 ; Makhado & Seekane 2020 ; Ncube et al 2014 ; Sultan et al 2014 ; Chimoyi et al 2022 ). The ill knowledge of PEP procedures shows the importance of follow-ups.…”

Cohort profile: CareConekta: a pilot study of a smartphone application to improve engagement in postpartum HIV care in South Africa

“…[4][5][6][7][8][9] Various studies have identified and documented barriers to engagement in HIV care, including medication side effects, complexity of dosing schedules, low patient education level, poverty, stigma, distance and transportation challenges, quality of care received and reliance on traditional medicines. [10][11][12][13] However, one potential barrier to continuous engagement in HIV care and treatment that is gaining attention is the mobility of people between regions and countries. 7 14 15 In 2011, UNAIDS and the International Organization for Migration, signed an agreement recognising HIV-related challenges faced by mobile populations with objectives to integrate human rights and the needs of mobile populations into national and regional HIV responses and to ensure universal access to HIV prevention, treatment, care and support.…”