Abstract
To maximize the benefits of test and treat strategies that utilize community-based HIV testing, clients who test positive must link to care in a timely manner. However, linkage rates across the HIV treatment cascade are typically low and little is known about what might facilitate or hinder care-seeking behavior. This qualitative study was conducted within a home-based HIV counseling and testing (HBHCT) intervention in South Africa. In-depth interviews were conducted with 30 HBHCT clients who tested HIV positive to explore what influenced their care-seeking behavior. A set of field notes for 196 additional HBHCT clients who tested HIV positive at home were also reviewed and analyzed. Content analysis showed that linkage to care is influenced by a myriad of factors at the individual, relationship, community, and health system levels. These factors subtly interact and at times reinforce each other. While some factors such as belief in test results, coping ability, social support, and prior experiences with the health system affect clients’ desire and motivation to seek care, others such as limited time and resources affect their agency to do so. To ensure that the benefits of community-based testing models are realized through timely linkage to care, programs and interventions must take into account and address clients’ emotions, motivation levels, living situations, relationship dynamics, responsibilities, and personal resources.
Highlights
Bold efforts to reduce the burden of the AIDS epidemic are increasingly a priority at both global and national levels
This qualitative descriptive study was nested within a cluster randomized control trial (RCT) of home-based HIV counseling and testing (HBHCT) uptake conducted in Umzimkhulu from September 2009 to January 2011
Among the 30 clients who participated in an in-depth interview, 24 (80%) were female and 6 (20%) were male, reflecting the underlying population
Summary
Bold efforts to reduce the burden of the AIDS epidemic are increasingly a priority at both global and national levels. By the year 2020, 90% of all people living with HIV will know their status, 90% of all people diagnosed will receive antiretroviral treatment (ART), and 90% of all people receiving ART will be virally suppressed [1] Reaching these targets will require countries to invest in a variety of strategies. One such approach is ‘‘test and treat’’ whereby countries implement large-scale testing programs to identify HIV positive individuals, and follow up with immediate treatment regardless of CD4 count [2]. If successfully implemented, it would yield reductions in rates of HIV transmission and death [3, 4]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
