“Ashamed of being seen in an HIV clinic”: a qualitative analysis of barriers to engaging in HIV care from the perspectives of patients and healthcare workers in the Daraja clinical trial
Abstract Background There is high post-hospital discharge mortality among persons with HIV who are hospitalized, and post-hospital survival is strongly associated with early HIV clinic linkage, clinic attendance, and antiretroviral therapy adherence. The Daraja intervention, a context-tailored case...
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2025-01-01
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| Online Access: | https://doi.org/10.1186/s12889-024-21231-z |
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| author | Elialilia S. Okello Robert N. Peck Benson Issarow Godfrey Kisigo Kelvin Abel Donati Malibwa Severin Kabakama Marco Charles Myung Lee Thomas Rutachunzibwa Daniel Fitzgerald Philip Ayieko Heiner Grosskurth Lisa R. Metsch Saidi Kapiga |
| author_facet | Elialilia S. Okello Robert N. Peck Benson Issarow Godfrey Kisigo Kelvin Abel Donati Malibwa Severin Kabakama Marco Charles Myung Lee Thomas Rutachunzibwa Daniel Fitzgerald Philip Ayieko Heiner Grosskurth Lisa R. Metsch Saidi Kapiga |
| author_sort | Elialilia S. Okello |
| collection | DOAJ |
| description | Abstract Background There is high post-hospital discharge mortality among persons with HIV who are hospitalized, and post-hospital survival is strongly associated with early HIV clinic linkage, clinic attendance, and antiretroviral therapy adherence. The Daraja intervention, a context-tailored case management strategy implemented and tested through a randomized trial in Tanzania, was associated with improved HIV clinic linkage, retention, and ART initiation and adherence. Methods We conducted in-depth interviews (IDIs) in a sub-sample of 40 study participants (20 control and 20 intervention) 12 months after enrollment into the trial to gain an in-depth understanding of the barriers to HIV care engagement and the perceived mechanisms through which the Daraja intervention impacted these barriers. We also conducted IDIs with 20 health care providers. We used a thematic analysis approach to generate themes following the Gelberg-Andersen behavioral model for vulnerable population domains. Results Perceived stigma, coupled with the mistrust of healthcare providers, underemployment or lack of reliable income, unreliable transport, and a lack of social support, were identified as key barriers to HIV clinic attendance and ART adherence. Perceived stigma complicated not only linking to and attending an HIV clinic but also decision-making regarding the choice of the clinic’s location. The Daraja intervention was reported to help normalise HIV diagnosis, plug the social support gap, increase patients’ self-efficacy and their capacity of participants to navigate the HIV clinic during HIV clinic linkage. Conclusion These qualitative research results identified several important barriers to engaging in HIV care and provide insights into the mechanisms through which the Daraja intervention operated to affect the perceived stigma, social support, self-efficacy, and increased capacity of participants to navigate the HIV clinic during HIV clinic linkage. Daraja trial registration ClinicalTrials.gov, NCT03858998. Registered on 01 March 2019. |
| format | Article |
| id | doaj-art-c19c54239bff494aa79fa8132c209ef1 |
| institution | Kabale University |
| issn | 1471-2458 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Public Health |
| spelling | doaj-art-c19c54239bff494aa79fa8132c209ef12025-01-12T12:42:44ZengBMCBMC Public Health1471-24582025-01-0125111210.1186/s12889-024-21231-z“Ashamed of being seen in an HIV clinic”: a qualitative analysis of barriers to engaging in HIV care from the perspectives of patients and healthcare workers in the Daraja clinical trialElialilia S. Okello0Robert N. Peck1Benson Issarow2Godfrey Kisigo3Kelvin Abel4Donati Malibwa5Severin Kabakama6Marco Charles7Myung Lee8Thomas Rutachunzibwa9Daniel Fitzgerald10Philip Ayieko11Heiner Grosskurth12Lisa R. Metsch13Saidi Kapiga14Mwanza Intervention Trials Unit, National Institute for Medical ResearchMwanza Intervention Trials Unit, National Institute for Medical ResearchMwanza Intervention Trials Unit, National Institute for Medical ResearchMwanza Intervention Trials Unit, National Institute for Medical ResearchMwanza Intervention Trials Unit, National Institute for Medical ResearchMwanza Intervention Trials Unit, National Institute for Medical ResearchMwanza Intervention Trials Unit, National Institute for Medical ResearchMwanza Intervention Trials Unit, National Institute for Medical ResearchCenter for Global Health, Department of Medicine, Weill Cornell MedicineCommunity Development, Gender, Elderly, and Children, Ministry of HealthCenter for Global Health, Department of Medicine, Weill Cornell MedicineMwanza Intervention Trials Unit, National Institute for Medical ResearchMwanza Intervention Trials Unit, National Institute for Medical ResearchDepartment of Sociomedical Sciences, Mailman School of Public Health, Columbia UniversityMwanza Intervention Trials Unit, National Institute for Medical ResearchAbstract Background There is high post-hospital discharge mortality among persons with HIV who are hospitalized, and post-hospital survival is strongly associated with early HIV clinic linkage, clinic attendance, and antiretroviral therapy adherence. The Daraja intervention, a context-tailored case management strategy implemented and tested through a randomized trial in Tanzania, was associated with improved HIV clinic linkage, retention, and ART initiation and adherence. Methods We conducted in-depth interviews (IDIs) in a sub-sample of 40 study participants (20 control and 20 intervention) 12 months after enrollment into the trial to gain an in-depth understanding of the barriers to HIV care engagement and the perceived mechanisms through which the Daraja intervention impacted these barriers. We also conducted IDIs with 20 health care providers. We used a thematic analysis approach to generate themes following the Gelberg-Andersen behavioral model for vulnerable population domains. Results Perceived stigma, coupled with the mistrust of healthcare providers, underemployment or lack of reliable income, unreliable transport, and a lack of social support, were identified as key barriers to HIV clinic attendance and ART adherence. Perceived stigma complicated not only linking to and attending an HIV clinic but also decision-making regarding the choice of the clinic’s location. The Daraja intervention was reported to help normalise HIV diagnosis, plug the social support gap, increase patients’ self-efficacy and their capacity of participants to navigate the HIV clinic during HIV clinic linkage. Conclusion These qualitative research results identified several important barriers to engaging in HIV care and provide insights into the mechanisms through which the Daraja intervention operated to affect the perceived stigma, social support, self-efficacy, and increased capacity of participants to navigate the HIV clinic during HIV clinic linkage. Daraja trial registration ClinicalTrials.gov, NCT03858998. Registered on 01 March 2019.https://doi.org/10.1186/s12889-024-21231-zBarriersClinic attendanceART adherencePerceived stigmaTanzania |
| spellingShingle | Elialilia S. Okello Robert N. Peck Benson Issarow Godfrey Kisigo Kelvin Abel Donati Malibwa Severin Kabakama Marco Charles Myung Lee Thomas Rutachunzibwa Daniel Fitzgerald Philip Ayieko Heiner Grosskurth Lisa R. Metsch Saidi Kapiga “Ashamed of being seen in an HIV clinic”: a qualitative analysis of barriers to engaging in HIV care from the perspectives of patients and healthcare workers in the Daraja clinical trial BMC Public Health Barriers Clinic attendance ART adherence Perceived stigma Tanzania |
| title | “Ashamed of being seen in an HIV clinic”: a qualitative analysis of barriers to engaging in HIV care from the perspectives of patients and healthcare workers in the Daraja clinical trial |
| title_full | “Ashamed of being seen in an HIV clinic”: a qualitative analysis of barriers to engaging in HIV care from the perspectives of patients and healthcare workers in the Daraja clinical trial |
| title_fullStr | “Ashamed of being seen in an HIV clinic”: a qualitative analysis of barriers to engaging in HIV care from the perspectives of patients and healthcare workers in the Daraja clinical trial |
| title_full_unstemmed | “Ashamed of being seen in an HIV clinic”: a qualitative analysis of barriers to engaging in HIV care from the perspectives of patients and healthcare workers in the Daraja clinical trial |
| title_short | “Ashamed of being seen in an HIV clinic”: a qualitative analysis of barriers to engaging in HIV care from the perspectives of patients and healthcare workers in the Daraja clinical trial |
| title_sort | ashamed of being seen in an hiv clinic a qualitative analysis of barriers to engaging in hiv care from the perspectives of patients and healthcare workers in the daraja clinical trial |
| topic | Barriers Clinic attendance ART adherence Perceived stigma Tanzania |
| url | https://doi.org/10.1186/s12889-024-21231-z |
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