Test and treat: the early experiences in a clinic serving women at high risk of HIV infection in Kampala
Open accessAbstract
At the end of 2013, the Government of Uganda issued guidance recommending provision of Anti-Retroviral Treatment (ART) to HIV-positive people in key populations, including female sex workers, regardless of CD4 cell count. We describe the implementation of this new guidance in a clinic serving women at high risk of HIV infection in Kampala. Between July and December 2015, we conducted repeat in-depth interviews with 15 women attending the clinic after the change in guidelines, to explore their perceptions regarding prompt ART initiation. The sample included some women who were HIV-negative and women who had both started and deferred ART. We conducted a data-led thematic analysis of the material from the interviews. A total of 257 of 445 eligible women had started ART; others were undecided or had not returned to the clinic after receiving the new information. Participants recounted varying experiences with the provision of prompt treatment. At an individual level, a history of treatment for opportunistic infections and other illnesses, coupled with relatively poor health, encouraged some to initiate ART promptly. However, knowledge of friends/relatives already on ART who had experienced side effects caused others to delay starting, fearing the same experience for themselves. A number of women questioned why they should start treatment when they were not sick. Situational factors such as work and residence (with many sharing single rooms) caused discomfort among newly diagnosed women who feared disclosure and stigma that would result from taking ART when they were not ill. Alcohol consumption and irregular working hours affected perceptions of future adherence, making prompt ART harder to embrace for some. Our findings show the challenges that influence the delay of treatment initiation, and/or the decision to defer receiving information on ART, with implications for the success of the test and treat programmes and guidelines.
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In the Uganda study, the change in guidelines to universal ART conflicted with the information participants had previously received about when to start ART.
“The change in guidelines to universal ART conflicted with the information they had previously received regarding when to start ART.”
From Echoes of old HIV paradigms: reassessing the problem of engaging men in HIV testing and treatment through women’s perspectives (2017) · cites this paper as [8]
A study in Uganda found that HIV-positive individuals who had been positive for some time and became eligible for ART under universal ART guidelines were more likely to delay starting ART compared to newly diagnosed individuals.
“A study in Uganda found that those who had been HIV-positive for some time and had become eligible for ART under the new “universal ART” guidelines were more likely to delay their decision to start ART compared to those who were newly diagnosed.”
From Echoes of old HIV paradigms: reassessing the problem of engaging men in HIV testing and treatment through women’s perspectives (2017) · cites this paper as [8]
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“This is a tried and tested approach and we have successfully conducted interviews without tape recorders with this population in our previous work (Mbonye, Nakamanya, Nalukenge, et al., 2013; Mbonye et al., 2012; Mbonye, Rutakumwa, Weiss, & Seeley, 2014).”
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BackgroundSelf-citation
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“Whereas many clinicians who treat HIV infection were likely aware of these effects before this study was published [33], there are accruing data that such protective individual benefits of ART are not always known among people with HIV [34, 35].”
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“Considering the time it will take to allow people to reconcile themselves to their new confirmed reality that they are HIV-positive before initiating treatment has received relatively little attention within the shift towards test and treat (Mbonye et al., 2016).”
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“While others have examined the factors influencing ART initiation among asymptomatic PLHIV within Treat-all [37-39], our study builds on these findings and provides insight into the influences on ongoing, longer term treatment taking, after an average of 20 months on ART.”
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Self-citationHIV testing service utilization and linkage to care under UTT in North-West South Africa
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- Authors
- Mbonye, M., Seeley, J., Nalugya, R., Kiwanuka, T., Bagiire, D., Mugyenyi, M., Namale, G., Mayanja, Y., & Kamali, A.
- Affiliations
- MRC/UVRI & LSHTM Uganda Research Unit (UG)
- London School of Hygiene & Tropical Medicine (GB)
- Corresponding author
- Mbonye, Martin
- Venue
- AIDS Care
- Publisher
- Informa UK Limited
- Published
- 2016-06-02
- Volume
- 28
- Issue
- sup3
- Pages
- 33-38
- ISSN
- 0954-0121 (ISSN-L)
- 1360-0451
- OpenAlex
- W2472147776
- Cited by
- 33
- References
- 23
- Citations by year
- 2025: 2 · 2024: 3 · 2023: 1 · 2022: 1 · 2021: 2 · 2020: 8 · 2019: 6 · 2018: 5 · 2017: 4 · 2016: 1
- FWCI
- 4.93
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- AIDS Care (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- Funders
- Department for International Development (00)
- Topics
- Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
- Health Sciences › Medicine › Epidemiology › HIV, Drug Use, Sexual Risk
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › HIV/AIDS Impact and Responses
- Keywords
- test and treat, HIV, antiretroviral therapy initiation, deferred treatment, treatment side effects, stigma, disclosure, medication adherence, alcohol consumption, opportunistic infections, key populations, Kampala
- MeSH terms
- Adult, Alcohol Drinking, Female, Humans, Interviews as Topic, Middle Aged, Patient Acceptance of Health Care, Perception, Risk, Time Factors, Uganda, HIV Infections, CD4 Lymphocyte Count, Antiretroviral Therapy, Highly Active, Qualitative Research, Social Stigma, Sex Workers
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