Abstract
Background UNAIDS has set a new target 90-90-90 by 2020. To achieve this target, current programs need to address challenges that limit access, availability, and utilization of HIV testing and treatment services. Therefore, the aim of this study was to identify the barriers that influence access, availability, and utilization of HIV services in rural Uganda within the setting of a large donor funded program. Methods We conducted key informant interviews with stakeholders at the district level, staff of existing HIV/AIDS projects, and health facilities in 19 districts. Data were also collected from focus group discussions comprised of clients presenting for HIV care and treatment. Data were transcribed and analyzed using content analysis. Results. Barriers identified were as follows: (1) drug shortages including antiretroviral drugs at health facilities. Some patients were afraid to start ART because of worrying about shortages; (2) distance and (3) staffing shortages; (4) stigma persistence; (5) lack of social and economic support initiatives that enhance retention in treatment. Conclusions In conclusion, our study has identified several factors that influence access, availability, and utilization of HIV services. Programs need to address drug and staff shortages, HIV stigma, and long distances to health facilities to broaden access and utilization in order to realize the UNAIDS target.
Highlights
UNAIDS has set a new target 90-90-90 by 2020
In order to achieve an AIDS-free generation, the UNAIDS has set an ambitious target code named 90-90-90, which aims to ensure that 90% of all people living with HIV will know their status, 90% of all people diagnosed will receive sustained antiretroviral therapy (ART), and 90% of all people receiving ART will have viral suppression, all by 2020 [1]
According to the Uganda AIDS commission, only 51% of adults aged from 15 to 49 have taken an HIV test in the past 12 months and know their serostatus [3] and estimated 57% of HIV positive adults are on ART [4] and national population level viral load suppression is estimated at 60% [2] far below the UNAIDS targets
Summary
UNAIDS has set a new target 90-90-90 by 2020. To achieve this target, current programs need to address challenges that limit access, availability, and utilization of HIV testing and treatment services. In order to achieve an AIDS-free generation, the UNAIDS has set an ambitious target code named 90-90-90, which aims to ensure that 90% of all people living with HIV will know their status, 90% of all people diagnosed will receive sustained antiretroviral therapy (ART), and 90% of all people receiving ART will have viral suppression, all by 2020 [1] To achieve this target, countries will need to review the current programs to identify the potential barriers that might hinder the achievement of these goals. Current data show numerous socioeconomic and cultural barriers inhibiting access to services and retention in care and these include difficulties in reaching clinics and poverty due to lack of social and financial support [5] These barriers have been documented in Uganda but mostly within the context of research intensive settings [6, 7]. These barriers need to be studied in real life settings and programs that are ongoing provide an ideal framework to study these barriers
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