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dc.contributor.authorNhassengo, Pedroso
dc.contributor.authorCataldo, Fabian; orcid: 0000-0001-8980-8951
dc.contributor.authorMagaço, Amilcar
dc.contributor.authorHoffman, Risa M; orcid: 0000-0001-9575-4574
dc.contributor.authorNerua, Lucas
dc.contributor.authorSaide, Mohomede
dc.contributor.authorCuco, Rosa; orcid: 0000-0003-1589-7044
dc.contributor.authorHoek, Roxanne
dc.contributor.authorMbofana, Francisco
dc.contributor.authorCouto, Aleny
dc.contributor.authorGudo, Eduardo; orcid: 0000-0002-8686-7873
dc.contributor.authorChicumbe, Sergio
dc.contributor.authorDovel, Kathryn; orcid: 0000-0002-5622-3401
dc.identifierpubmed: 30586354
dc.identifierdoi: 10.1371/journal.pone.0205919
dc.identifierpii: PONE-D-18-13957
dc.identifier.citationPloS one, volume 13, issue 12, page e0205919
dc.descriptionFrom PubMed via Jisc Publications Router.
dc.descriptionHistory: received 2018-05-08, accepted 2018-10-02
dc.descriptionPublication status: epublish
dc.description.abstractIn mid-2016, Mozambique began phased implementation of the 'Test-and-Treat' policy, which enrolls HIV positive clients into antiretroviral treatment (ART) immediately regardless of CD4 cell count or disease stage. Novel insights into barriers and facilitators to ART initiation among healthy clients are needed to improve implementation of Test and Treat. A cross-sectional qualitative study was conducted across 10 health facilities in Mozambique. In-depth interviews (IDIs) were conducted with HIV-positive clients (60 who initiated/20 who did not initiate ART within Test and Treat) and 9 focus group discussion (FGDs) were conducted with health care workers (HCWs; n = 53). Data were analyzed using deductive and inductive analysis strategies. Barriers to ART initiation included: (1) feeling 'healthy'; (2) not prepared to start ART for life; (3) concerns about ART side effects; (4) fear of HIV disclosure and discrimination; (5) poor interactions with HCWs; (6) limited privacy at health facilities; and (7) perceptions of long wait times. Facilitators included the motivation to stay healthy and to take care of dependents, as well as new models of ART services such as adaptation of counseling to clients' specific needs, efficient patient flow, and integrated HIV/primary care services. ART initiation may be difficult for healthy clients in the context of Test-and-Treat. Specific strategies to engage this population are needed. Strategies could include targeted support for clients, community sensitization on the benefits of early ART initiation, client-centered approaches to patient care, and improved efficiency through multi-month scripting and increased workforce.
dc.sourceeissn: 1932-6203
dc.titleBarriers and facilitators to the uptake of Test and Treat in Mozambique: A qualitative study on patient and provider perceptions.

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