'I need time to start antiretroviral therapy': understanding reasons for delayed ART initiation among people diagnosed with HIV in Lusaka, Zambia

Mwamba, Chanda, Beres, Laura, Topp, Stephanie M., Mukamba, Njekwa, Simbeza, Sandra, Sikombe, Kombatende, Mody, Aaloke, Geng, Elvin, Holmes, Charles B., Kennedy, Caitlin E., Sikazwe, Izukanji, Denison, Julie A., and Bolton Moore, Carolyn (2022) 'I need time to start antiretroviral therapy': understanding reasons for delayed ART initiation among people diagnosed with HIV in Lusaka, Zambia. Annals of Medicine, 54 (1). pp. 830-836.

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Abstract

Introduction

Rapid antiretroviral therapy (ART) initiation can improve patient outcomes such as viral suppression and prevent new infections. However, not everyone who can start ART does so immediately. Methods

We conducted a qualitative study to inform interventions supporting rapid initiation in the ‘Test and Start’ era. We purposively sampled 20 adult patients living with HIV and a previous gap in care from ten health facilities in Lusaka, Zambia for interviews. We inductively analysed transcripts using a thematic, narrative approach. In their narratives, seven participants discussed delaying ART initiation. Results

Drawing on messages gleaned from facility-based counselling and community information, many cited greater fear of rapid sickness or death due to imperfect adherence or treatment side effects than negative health consequences due to delayed initiation. Participants described needing time to ‘prepare’ their minds for a lifetime treatment commitment. Concerns about inadvertent HIV status disclosure during drug collection discouraged immediate initiation, as did feeling healthy, and worries about the impact of ART initiation on relationship dynamics. Conclusion

Findings suggest that counselling messages should accurately communicate treatment risks, without perpetuating fear-based narratives about HIV. Identifying and managing patient-specific concerns and reasons for the ‘need for time’ may be important for supporting individuals to rapidly accept lifelong treatment.

Item ID: 73122
Item Type: Article (Research - C1)
ISSN: 1365-2060
Copyright Information: © 2022 The Author(s). Published by lnforma UK Limited, trading as Taylor & Francis Group. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Date Deposited: 10 Apr 2022 21:14
FoR Codes: 42 HEALTH SCIENCES > 4203 Health services and systems > 420307 Health counselling @ 40%
42 HEALTH SCIENCES > 4203 Health services and systems > 420305 Health and community services @ 20%
42 HEALTH SCIENCES > 4203 Health services and systems > 420319 Primary health care @ 40%
SEO Codes: 20 HEALTH > 2002 Evaluation of health and support services > 200206 Health system performance (incl. effectiveness of programs) @ 60%
20 HEALTH > 2003 Provision of health and support services > 200310 Primary care @ 40%
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