Provider and Patient Perspectives of Rapid ART Initiation and Streamlined HIV Care: Qualitative Insights From Eastern African Communities
The Sustainable East Africa Research in Community Health (SEARCH), a universal test and treat (UTT) trial, implemented ‘Streamlined Care’—a multicomponent strategy including rapid linkage to care and antiretroviral therapy (ART) start, 3-monthly refills, viral load counseling, and accessible, patien...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
SAGE Publishing
2021-11-01
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| Series: | Journal of the International Association of Providers of AIDS Care |
| Online Access: | https://doi.org/10.1177/23259582211053518 |
| _version_ | 1818402773998239744 |
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| author | Florence Mwangwa Monica Getahun Harriet Itiakorit Vivek Jain James Ayieko Lawrence Owino Cecilia Akatukwasa Irene Maeri Catherine A. Koss Gabriel Chamie Tamara D. Clark Jane Kabami Mucunguzi Atukunda Dalsone Kwarisiima Norton Sang Elizabeth A. Bukusi Moses R. Kamya Maya L. Petersen Craig R. Cohen Edwin D. Charlebois Diane V. Havlir Carol S. Camlin |
| author_facet | Florence Mwangwa Monica Getahun Harriet Itiakorit Vivek Jain James Ayieko Lawrence Owino Cecilia Akatukwasa Irene Maeri Catherine A. Koss Gabriel Chamie Tamara D. Clark Jane Kabami Mucunguzi Atukunda Dalsone Kwarisiima Norton Sang Elizabeth A. Bukusi Moses R. Kamya Maya L. Petersen Craig R. Cohen Edwin D. Charlebois Diane V. Havlir Carol S. Camlin |
| author_sort | Florence Mwangwa |
| collection | DOAJ |
| description | The Sustainable East Africa Research in Community Health (SEARCH), a universal test and treat (UTT) trial, implemented ‘Streamlined Care’—a multicomponent strategy including rapid linkage to care and antiretroviral therapy (ART) start, 3-monthly refills, viral load counseling, and accessible, patient-centered care provision. To understand patient and provider experiences of Streamlined Care to inform future care innovations, we conducted in-depth interviews with patients ( n = 18) and providers ( n = 28) at baseline (2014) and follow-up (2015) ( n = 17 patients; n = 21 providers). Audio recordings were transcribed, translated, and deductively and inductively coded. Streamlined Care helped to decongest clinic spaces and de-stigmatize human immunodeficiency virus (HIV) care. Patients credited the individualized counselling, provider-assisted HIV status disclosure, and providers’ knowledge of patient's drug schedules, availability, and phone call reminders for their care engagement. However, for some, denial (repeated testing to disprove HIV+ results), feeling healthy, limited understanding of the benefits of early ART, and anticipated side-effects, and mistrust of researchers hindered rapid ART initiation. Patients’ short and long-term mobility proved challenging for both patients and providers. Providers viewed viral load counselling as a powerful tool to convince otherwise healthy and high-CD4 patients to initiate ART. Patient-centered HIV care models should build on the successes of Streamlined Care, while addressing persistent barriers. #NCT01864683— https://clinicaltrials.gov/ct2/show/NCT01864603 |
| first_indexed | 2024-12-14T08:13:42Z |
| format | Article |
| id | doaj.art-cfe503c4590f483da7fd18ef4c9d9b7b |
| institution | Directory Open Access Journal |
| issn | 2325-9582 |
| language | English |
| last_indexed | 2024-12-14T08:13:42Z |
| publishDate | 2021-11-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Journal of the International Association of Providers of AIDS Care |
| spelling | doaj.art-cfe503c4590f483da7fd18ef4c9d9b7b2022-12-21T23:10:01ZengSAGE PublishingJournal of the International Association of Providers of AIDS Care2325-95822021-11-012010.1177/23259582211053518Provider and Patient Perspectives of Rapid ART Initiation and Streamlined HIV Care: Qualitative Insights From Eastern African CommunitiesFlorence Mwangwa0Monica Getahun1Harriet Itiakorit2Vivek Jain3James Ayieko4Lawrence Owino5Cecilia Akatukwasa6Irene Maeri7Catherine A. Koss8Gabriel Chamie9Tamara D. Clark10Jane Kabami11Mucunguzi Atukunda12Dalsone Kwarisiima13Norton Sang14Elizabeth A. Bukusi15Moses R. Kamya16 Maya L. Petersen17Craig R. Cohen18Edwin D. Charlebois19 Diane V. Havlir20Carol S. Camlin21 , Kampala, Uganda University of California, San Francisco, USA , Kampala, Uganda , San Francisco, USA , Nairobi, Kenya , Nairobi, Kenya , Kampala, Uganda , Nairobi, Kenya , San Francisco, USA , San Francisco, USA , San Francisco, USA , Kampala, Uganda , Kampala, Uganda , Kampala, Uganda , Nairobi, Kenya , Nairobi, Kenya , Kampala, Uganda , Berkeley, USA University of California, San Francisco, USA University of California, San Francisco, San Francisco, CA, USA , San Francisco, USA University of California, San Francisco, San Francisco, CA, USAThe Sustainable East Africa Research in Community Health (SEARCH), a universal test and treat (UTT) trial, implemented ‘Streamlined Care’—a multicomponent strategy including rapid linkage to care and antiretroviral therapy (ART) start, 3-monthly refills, viral load counseling, and accessible, patient-centered care provision. To understand patient and provider experiences of Streamlined Care to inform future care innovations, we conducted in-depth interviews with patients ( n = 18) and providers ( n = 28) at baseline (2014) and follow-up (2015) ( n = 17 patients; n = 21 providers). Audio recordings were transcribed, translated, and deductively and inductively coded. Streamlined Care helped to decongest clinic spaces and de-stigmatize human immunodeficiency virus (HIV) care. Patients credited the individualized counselling, provider-assisted HIV status disclosure, and providers’ knowledge of patient's drug schedules, availability, and phone call reminders for their care engagement. However, for some, denial (repeated testing to disprove HIV+ results), feeling healthy, limited understanding of the benefits of early ART, and anticipated side-effects, and mistrust of researchers hindered rapid ART initiation. Patients’ short and long-term mobility proved challenging for both patients and providers. Providers viewed viral load counselling as a powerful tool to convince otherwise healthy and high-CD4 patients to initiate ART. Patient-centered HIV care models should build on the successes of Streamlined Care, while addressing persistent barriers. #NCT01864683— https://clinicaltrials.gov/ct2/show/NCT01864603https://doi.org/10.1177/23259582211053518 |
| spellingShingle | Florence Mwangwa Monica Getahun Harriet Itiakorit Vivek Jain James Ayieko Lawrence Owino Cecilia Akatukwasa Irene Maeri Catherine A. Koss Gabriel Chamie Tamara D. Clark Jane Kabami Mucunguzi Atukunda Dalsone Kwarisiima Norton Sang Elizabeth A. Bukusi Moses R. Kamya Maya L. Petersen Craig R. Cohen Edwin D. Charlebois Diane V. Havlir Carol S. Camlin Provider and Patient Perspectives of Rapid ART Initiation and Streamlined HIV Care: Qualitative Insights From Eastern African Communities Journal of the International Association of Providers of AIDS Care |
| title | Provider and Patient Perspectives
of Rapid ART Initiation and Streamlined
HIV Care: Qualitative Insights From
Eastern African Communities |
| title_full | Provider and Patient Perspectives
of Rapid ART Initiation and Streamlined
HIV Care: Qualitative Insights From
Eastern African Communities |
| title_fullStr | Provider and Patient Perspectives
of Rapid ART Initiation and Streamlined
HIV Care: Qualitative Insights From
Eastern African Communities |
| title_full_unstemmed | Provider and Patient Perspectives
of Rapid ART Initiation and Streamlined
HIV Care: Qualitative Insights From
Eastern African Communities |
| title_short | Provider and Patient Perspectives
of Rapid ART Initiation and Streamlined
HIV Care: Qualitative Insights From
Eastern African Communities |
| title_sort | provider and patient perspectives of rapid art initiation and streamlined hiv care qualitative insights from eastern african communities |
| url | https://doi.org/10.1177/23259582211053518 |
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