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Stumbling Blocks at the Clinic: Experiences of Seeking HIV Treatment and Care in South Africa

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Abstract

Prompt antiretroviral therapy (ART) initiation maximises the therapeutic and prevention benefits of a treat-all strategy for HIV therapy. Using in-depth semi-structured interviews with men and women 18 years and older (N = 41), who were highly motivated and seeking treatment, this study examined salient factors that were associated with delays in treatment access and initiation. Results revealed clinic-related barriers including an onerous, inefficient multi-step process to initiate ART. Participants experienced additional delays due to difficulties accessing care (e.g., being turned away from clinics and referred elsewhere) and health service challenges. Health service challenges included difficulty securing appointments, administrative mistakes (especially lost clinic folders and test results), difficulty navigating the clinic system (e.g., failure to collect a queue card or waiting for incorrect services) and negative clinic-patient interactions. Overall, there was a pervasive negative perception of clinics. Results strongly indicate the need for more patient-centred models of care and the need to reduce unnecessary patient-days at clinics.

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Acknowledgements

The authors gratefully acknowledge the staff of the Tutu Tester Mobile Clinic for their significant contribution to the iLink study fieldwork and Genoviva Sowemimo-Coker who made a valuable contribution to the data analysis.

Funding

This study was partially funded by the National Research Foundation, South Africa, through the Research Career Advancement Fellowship. Support for this study was also provided by the South African Social Science and HIV (SASH) Programme, an initiative funded by the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health (Award #R24HD077976). CK and ML derived support for analysis, interpretation and writing from the National Institute of Mental Health (Grants K01MH 096646 and R01 MH106600). The content is solely the responsibility of the authors and does not necessarily represent the official views of the funders.

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Authors and Affiliations

  1. Southern Africa Labour and Development Research Unit, University of Cape Town, Rondebosch, Cape Town, 7701, South Africa

    Brendan Maughan-Brown

  2. Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa

    Caroline Kuo

  3. Department of Behavioral and Social Sciences and Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA

    Caroline Kuo

  4. Department of Health Services, Policy & Practice (HSPP), Brown University School of Public Health, Providence, RI, USA

    Omar Galárraga

  5. The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa

    Philip Smith & Linda-Gail Bekker

  6. Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA

    Mark N. Lurie

  7. Department of Behavioral and Social Sciences, Brown University School of Public Health Providence, Providence, RI, USA

    Abigail Harrison

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  1. Brendan Maughan-Brown
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  2. Caroline Kuo
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Corresponding author

Correspondence to Brendan Maughan-Brown.

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Conflict of interest

All authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The Human Research Ethics Committee, Faculty of Health Sciences, University of Cape Town provided study approval (Ref: 849/2014).

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Informed consent was obtained from all individual participants included in the study.

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Maughan-Brown, B., Kuo, C., Galárraga, O. et al. Stumbling Blocks at the Clinic: Experiences of Seeking HIV Treatment and Care in South Africa. AIDS Behav 22, 765–773 (2018). https://doi.org/10.1007/s10461-017-1877-4

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  • DOI: https://doi.org/10.1007/s10461-017-1877-4

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