1. Barriers and Facilitators of Retention in a Decentralized HIV Treatment Program in North Central Nigeria: A Qualitative Analysis Kolawole GO1, Dadem NY1, Agaba PA1, Genberg BL2, Agbaji OO1, Sagay AS1, Okonkwo P3 Ware,NC4 1Jos University Teaching Hospital, Jos, Nigeria AIDS Prevention Initiative, Nigeria 2 Brown University, Providence, RI, USA 3 AIDS Prevention Initiative, Nigeria Ltd., Nigeria 4 Harvard Medical School, Boston, Massachusetts, USA
Background
Results
Participants reported saving money and time on transport to clinic appointments and experiences of improved health from ART as retention facilitators. A number of barriers were also pointed out including:
Figure 1.
Map of Africa Showing Nigeria
Decentralization of antiretroviral treatment (ART) and care seeks to link patients to services and improve retention by expanding delivery of ART from tertiary to secondary and primary health care settings. Decentralization efforts have been underway for several years in Africa, and retention rates have improved. Yet, we know little of patients’ experiences of transferring to new sites, or of receiving care in decentralized facilities. We conducted a qualitative study of patient experiences of decentralized care in Nigeria, focusing particularly on retention barriers and facilitators.
travel difficulties, due to poor roads and security checkpoints;
having to pay for medicines received for non-HIV ailments that had been provided free of charge at the previous care site;
long clinic waiting times; and
heightened fear of disclosure and resulting stigma.
Nigeria
Figure 2.
Open Waiting Areas Increase Disclosure Risk
“ …We have some women, … some persons, who time our clinic days and come around to see who is taking the drugs. We said, ‘Those persons should be warned. If they have nothing to do here -- either that they came for themselves or brought someone, they should not come around here.’ [These women come around to] see who will come to this clinic on a Thursday. Then, they go out to say ,’I saw this and that person at the HIV clinic. Alas, this person is taking medication …’” Female pt. interview.
Methods
We report qualitative data collected at five sites in a decentralized HIV care network in Plateau State, north central Nigeria. Seventy-five (N=75) adults who had transferred from a larger, central HIV specialty clinic and were receiving ART at local community hospitals took part in individual interviews. Another twenty-two (N=22) individuals participated in four focused group discussions. Data collection topics included reasons for transferring to the local clinic, experiences of decentralized care, experiences of keeping clinic appointments and perceived quality of services. Data were inductively content analyzed to identify themes.
Conclusion
Decentralization alleviates transport time and cost as barriers to retention but presents other structural and social obstacles to persisting in care. Some of these are similar to and some are different from obstacles reported previous for large, centralized treatment settings in sub-Saharan Africa.
Acknowledgement
Funding: U.S. National Institute of Mental Health (K24MH090894, NC Ware, PI)