ArticleAnnals of medicine2022
'I need time to start antiretroviral therapy': understanding reasons for delayed ART initiation among people diagnosed with HIV in Lusaka, Zambia'.
Article in Annals of medicine, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 1 of them a synthesis that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
10 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Same-day ART initiation, loss to follow-up and viral load suppression among people living with HIV in low- and middle-income countries: systematic review and meta-analysis.The Pan African medical journal · 2023Pooled it
- Beyond knowledge deficits: social visibility, family dynamics, and delayed initiation among people living with HIV in Southwestern China-a descriptive phenomenological study.BMC public health · 2026Article
- Thoughts of Death or Self-injury, Non-same-day ART Initiation, and 2-year Incidence of Disengagement from Care Among People Entering HIV Care in Cameroon.AIDS and behavior · 2026Article
- The Association Between HIV and Substance Use Stigma and Attitudes and Utilization of HIV Care Among Adults Who Use Injection Drugs: A Systematic Review.AIDS and behavior · 2026Article
- Viral Suppression Following Same-day Initiation Antiretroviral Therapy among Persons Aware of their Classification as Recent or Long-term Infected with HIV Per Recent Infection Testing Algorithm, Rwanda 2021-2022.AIDS and behavior · 2026Article
- Policymaker Perspectives on Implementation Determinants of Rapid ART and Same-Day PrEP in Seven Priority Jurisdictions for Ending the HIV Epidemic: A Multisite Qualitative Study.Journal of acquired immune deficiency syndromes (1999) · 2025Article
- Identifying longitudinal patterns of HIV treatment (dis)engagement and re-engagement from oral histories of virologically unsuppressed persons in Uganda: A thematic trajectory analysis.Social science & medicine (1982) · 2023Article
- Understanding gender differences of people with HIV newly diagnosed or returning to care with advanced HIV disease in Malawi: a qualitative study.BMC public health · 2023Article
- Game-based health education to improve ART adherence of newly diagnosed young people with HIV: protocol for a stepped-wedge design randomized controlled trial.BMC public health · 2022Article
- Psychosocial Health Factors Among Men Reporting Recent Sexual Assault.Journal of forensic nursingArticle
Corrections and comments
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Authors and funding
13 authors.
Funding
Abstract
introductionRapid 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.
methodsWe 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.
resultsDrawing 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.
conclusionFindings 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.Key messagesFear-based adherence messaging in health facilities about the dangers of missing a treatment dose or changing the time when ART is taken contributes to Zambian patients' refusals of immediate ART initiationResponsive health systems that balance a stated need for time to accept one's diagnosis and prepare to embark on a lifelong treatment plan with interventions to identify and manage patient-specific treatment related fears and concerns may support more rapid ART initiationPerceived social stigma around HIV continues to be a significant challenge for treatment initiation.
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