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11-01-2019 | Uitgave 5/2019

Journal of Behavioral Medicine 5/2019

Factors affecting linkage to HIV care and ART initiation following referral for ART by a mobile health clinic in South Africa: evidence from a multimethod study

Journal of Behavioral Medicine > Uitgave 5/2019
Brendan Maughan-Brown, Abigail Harrison, Omar Galárraga, Caroline Kuo, Philip Smith, Linda-Gail Bekker, Mark N. Lurie
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The online version of this article (https://​doi.​org/​10.​1007/​s10865-018-0005-x) contains supplementary material, which is available to authorized users.

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Linkage to care from mobile clinics is often poor and inadequately understood. This multimethod study assessed linkage to care and antiretroviral therapy (ART) uptake following ART-referral by a mobile clinic in Cape Town (2015/2016). Clinic record data (N = 86) indicated that 67% linked to care (i.e., attended a clinic) and 42% initiated ART within 3 months. Linkage to care was positively associated with HIV-status disclosure intentions (aOR: 2.99, 95% CI 1.13–7.91), and treatment readiness (aOR: 2.97, 95% CI 1.05–8.34); and negatively with good health (aOR: 0.35, 95% CI 0.13–0.99), weekly alcohol consumption (aOR: 0.35, 95% CI 0.12–0.98), and internalised stigma (aOR: 0.32, 95% CI 0.11–0.91). Following linkage, perceived stigma negatively affected ART-initiation. In-depth interviews (N = 41) elucidated fears about ART side-effects, HIV-status denial, and food insecurity as barriers to ART initiation; while awareness of positive ART-effects, follow-up telephone counselling, familial responsibilities, and maintaining health to avoid involuntary disclosure were motivating factors. Results indicate that an array of interventions are required to encourage rapid ART-initiation following mobile clinic HIV-testing services.

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