Policy and practice, lost in transition: Reasons for high drop-out from pre-antiretroviral care in a resource-poor setting of eastern Uganda
2010 (English)In: Health Policy, ISSN 0168-8510, Vol. 95, no 2-3, 153-158 p.Article in journal (Refereed) Published
Objective: This study explores reasons for drop-out from pre-ARV care in a resource-poor setting where premature death is a common consequence of delayed ARV initiation. Methods: In Iganga, Uganda, we conducted key informant interviews with staff at the pre-ARV clinic, focus group discussions with persons who looked after people living with HIV (PLWH) and in-depth interviews with PLWH half of whom had dropped out of pre-ARV care. Content data analysis was done to identify recurrent themes. Results: Reasons cited for dropping out of pre-ARV care include: inadequate post-test counseling due to staff work overload, competition from the holistic and less stigmatizing traditional/spiritual healers. Others were transportation costs, long waiting time lack of incentives to seek pre-ARV care by healthy looking PLWH and gender inequalities. Conclusions: Pre-ARV adherence counseling should be improved through recruitment of counselors or multi-skilling in counseling skills for the available staff to reduce on the work load. Traditional/ spiritual healers should be integrated and supervised to offer pre-ARV care. Door step supply of cotrimoxazole using agents could reduce transport costs, waiting time and increase access to pre-ARV. Women should be sensitized on comprehensive HIV care through the local media and local leaders to address gender inequalities.
Place, publisher, year, edition, pages
2010. Vol. 95, no 2-3, 153-158 p.
Loss to follow-up, Pre-ARV care
Medical and Health Sciences
IdentifiersURN: urn:nbn:se:uu:diva-136547DOI: 10.1016/j.healthpol.2009.11.021ISI: 000277761900008PubMedID: 20022131OAI: oai:DiVA.org:uu-136547DiVA: diva2:377279