Abstract
BackgroundMale engagement in HIV programs is a persistent challenge that results in poor utilization of HIV care services. Differentiated service delivery models, such as Community Client-Led Antiretroviral Delivery Groups (CCLADs), provide an opportunity for male engagement in HIV care. In southwestern Uganda. In southwestern Uganda few men living with HIV (MLWHIV) are involved in CCLADS. We aimed to identify facilitators, barriers and perceptions to CCLADs enrollment by MLWHIV at ART Clinics in southwestern Uganda.MethodsA qualitative study was conducted among MLWHIV who were registered and receiving ART at two ART Clinics/health facilities in southwestern Uganda, irrespective of their enrollment status into CCLADs. In-depth interviews (IDI) were conducted among recruited HIV positive men, and Key informant interviews (KIIs) among clinic in-charges and counselors, women enrolled in CCLADS using a semi-structured interview guide. We used thematic analysis to analyze the data from the interviews.ResultsWe conducted 16 interviews, 7 KII and 8 IDI were conducted. MLWHIV and key informants shared the facilitators and barriers. Men who were not involved in CCLADs shared the barriers to joining the CCLADs. The themes identified included 1. Motivations to join CCLADS 2. Challenges related to CCLADS initiation 3. Perceived facilitators for male participation in CCLADS, 4. Perceived barriers for male participation in CCLADS and 5. Proposed strategies for best implementation of CCLADs for better male engagement. Overall men liked the idea of CCLADs but they had preferences on how they should be implemented.ConclusionMen’s enrollment into CCLADs is still low despite the benefits. Addressing the barriers to men’s engagement and adopting proposed strategies may improve men’s enrollment in CCLADS and thus improve their access to ART, Adherence and quality of life.
Highlights
Antiretroviral therapy (ART) improves the quality of life of Persons Living with Human Immunodeficiency Virus (HIV) (PLWHIV) [1] Through lowering the viral load, improving the individual’s immunityKushemererwa et al BMC Health Services Research (2022) 22:125 and reducing the chances of getting opportunistic infections
The health facility staff advise individuals from the same area who meet the criteria for joining Community Client Lead ART Delivery Groups (CCLADS), to form a group where one individual comes to the clinic to collect the ART for the rest of the group members
Participants mentioned that Community Client-Led Antiretroviral Delivery Groups (CCLADs) reduce the frequency of going to the facility whereby one of the group members is the one who goes to the facility and the rest just contribute a certain amount of money which he uses as transport to and from the hospital saving money as one of our participants told us that, “They have helped us most of the time before we used to go and receive medicine every month, so where do you get such transport, but after introducing these groups, you go there once in 6 months, and you still keep receiving your medicine....” .P8-In-depth interviews (IDI)-04/2021. Another member of CCLADS mentioned that; “We were coming from a village far away and everyone was using like 15000shs for transport to come to the facility, so we discovered that if we are 6 people, you find that we have spent about 65000shs, so we decided to give that money to one person, 15000shs, so that he can come to the facility and receive for us our medicine” P1-IDI-04/2021
Summary
Kushemererwa et al BMC Health Services Research (2022) 22:125 and reducing the chances of getting opportunistic infections This is achieved through better ART access and adherence. In 2016, WHO endorsed the Differentiated Service Delivery Models (DSDM) program which was adapted in Uganda as a means to improve the health seeking behavior of PLWHIV in terms of access to treatment [2]. These groups are formed voluntarily by the people in the same community with the same interests and goals [3]. We aimed to identify facilitators, barriers and perceptions to CCLADs enrollment by MLWHIV at ART Clinics in southwestern Uganda
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