ArticlePloS one2016
Facilitators and Barriers of Antiretroviral Therapy Initiation among HIV Discordant Couples in Kenya: Qualitative Insights from a Pre-Exposure Prophylaxis Implementation Study.
Article in PloS one, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 28 papers, 2 of them syntheses that pooled it.
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Who cites it
28 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- The experience of healthcare workers to HIV pre-exposure prophylaxis (PrEP) implementation in low- and middle-income countries: a systematic review and qualitative meta-synthesis.Frontiers in public health · 2023Pooled it
- Point-of-care viral load tests to detect high HIV viral load in people living with HIV/AIDS attending health facilities.The Cochrane database of systematic reviews · 2022Pooled it
- Barriers and facilitators to the uptake of Test and Treat in Mozambique: A qualitative study on patient and provider perceptions.PloS one · 2018Trial
- Factors affecting the enrolment of men into a community adherence group in Kavango East Region, Namibia.African journal of primary health care & family medicine · 2026Article
- HIV Infection in Portugal: Measuring the Time Between Linkage to Care and Antiretroviral Therapy Initiation.Healthcare (Basel, Switzerland) · 2025Article
- Lived experiences of adults living With HIV/AIDS receiving antiretroviral therapy at werabe comprehensive specialized hospital in Silte zone, Ethiopia.Frontiers in reproductive health · 2025Article
- Post-intervention perceptions on the antiretroviral therapy community group model in Trans Nzoia County, Kenya.The Pan African medical journal · 2024Article
- Perspectives of people living with HIV on barriers to timely ART initiation following referral for antiretroviral therapy: A qualitative study at an urban HIV clinic in Kampala, Uganda.PLOS global public health · 2023Article
- Experiences of Antiretroviral Therapy Initiation Among HIV-Positive Adults in Ethiopia: A Descriptive Phenomenological Design.HIV/AIDS (Auckland, N.Z.) · 2022Article
- Identifying barriers to ART initiation and adherence: An exploratory qualitative study on PMTCT in Zambia.PloS one · 2022Article
- Preferences for Multipurpose Technology and Non-oral Methods of Antiretroviral Therapy Among Women Living With HIV in Western Kenya: A Survey Study.Frontiers in global women's health · 2022Article
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- Acceptability and Feasibility of Pharmacy-Based Delivery of Pre-Exposure Prophylaxis in Kenya: A Qualitative Study of Client and Provider Perspectives.AIDS and behavior · 2021Article
- Persons living with HIV in sero-discordant partnerships experience improved HIV care engagement compared with persons living with HIV in sero-concordant partnerships: a cross-sectional analysis of four African countries.AIDS research and therapy · 2021Article
- An implementation model for scaling up oral pre-exposure prophylaxis in Kenya:Gates open research · 2021Article
- Predictors of antiretroviral therapy initiation in eThekwini (Durban), South Africa: Findings from a prospective cohort study.PloS one · 2021Article
- Newly diagnosed HIV positive children: a unique index case to improve HIV diagnosis and linkage to care of parents.AIDS care · 2020Article
- "They haven't asked me. I haven't told them either": fertility plan discussions between women living with HIV and healthcare providers in western Ethiopia.Reproductive health · 2020Article
- High levels of viral repression, malnutrition and second-line ART use in adolescents living with HIV: a mixed methods study from Myanmar.BMC infectious diseases · 2020Article
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Authors and funding
8 authors.
Funding
Abstract
introductionThe World Health Organization now recommends antiretroviral therapy (ART) initiation for all HIV-infected individuals regardless of CD4 cell count or disease status. Understanding the facilitators and barriers to initiation of and adherence to ART is essential to successful scale-up of "universal" ART.
methodsTo investigate facilitators and barriers to ART initiation, we conducted 44 in-depth individual or couple interviews with 63 participants (33 participants with HIV and 30 without HIV) already enrolled in a prospective implementation study of oral antiretroviral-based prevention in Kisumu, Kenya between August and September 2014. A semi-structured interview guided discussions on: 1) perceived advantages and disadvantages of ART; 2) reasons for accepting or declining ART initiation; and 3) influence of prevention of transmission to partner or infant influencing ART use. Transcripts from the interviews were iteratively analyzed using inductive content analysis.
resultsHIV-infected participants indicated that living a healthier life, preventing HIV transmission to others, and appearing "normal" or "healthy" again facilitated their initiation of ART. While appearing "normal" allowed these individuals to interact with their communities without stigmatization, they also perceived community opposition to their initiating ART, because appearing "normal" again prevented community members from easily identifying infected individuals in their community. Denial of diagnosis, disclosure stigma, perceived side-effects, and challenges in obtaining refills were additional barriers to ART initiation.
conclusionsCommunity perceptions play an important role in both facilitating and inhibiting ART initiation. Perceived stigma, including perceived community opposition to widespread ART use, is an important barrier to ART initiation. Addressing such barriers, while capitalizing on facilitators, to ART initiation should be central to universal ART scale-up efforts.
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